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The Window of Opportunity (5.24.2024)

Dr. Jack Cush reviews the journal reports and news from the past week on This week: blockbuster drugs, opioids in rheumatology and nontreatment of inflammatory arthritis?

  1. No Link Between Autoimmune Diseases and Monoclonal Gammopathy of Undetermined Significance Annals of Internal Medicine reports a study of more than 75,000 persons screened for MGUS and found no association between AIRD and MGUS.
  2. Lille Univ Hosp study of 485 systemic sclerosis pts, found osteoporosis in 23% (18% w/ fragility Fx). OP independently linked to age (OR1.06), topoisomerase I Ab+ positivity (OR 2.22) & GC treatment (OR 4.48)
  3. Australian multicenter KARAOKE RCT of 262 adults w/ Knee OA (w/ MRI effusion/synovitis) Rx w/ placebo vs , 2 g/d of krill oil showed no significant benefit in pain VAS score, −19.9 [krill oil] vs −20.2 [placebo].
  4. Best Selling US Drugs in 2023 11 Skyrizi $10.1 billion 10 Dupixent $11.5 b 9 Biktarvy $13.15 b 8 Mounjaro $13.16 b 7 Keytruda $15.4 b 6 Stelara $15.87 b 5 Jardiance $15.89 b 4 Trulicity $16.3 b 3 Eliquis $22.1 b 2 Humira $35.3 b 1 Ozempic $38.6 b
  5. 384 Psoriasis pts followed mean 33 mos, 56 (14.6%) developed new-onset PsA. 311/384 (81%) had arthralgia (subclinical PsA) & 9.4% got PsA within 12 mos (23% by 36%). Subclinical more likely than PSO to get PsA (OR 11.7)
  6. Brazilian Registry of Spondyloarthritis study of 1096 SpA pts, found 73% HLA-B27 positivity. B27+ signif assoc w/ males, earlier onset/Dx, uveitis, +FHx. B27 negativity assoc w/ psoriasis, higher peripheral arthritis/disease activity, worse QOL, mobility
  7. MarketScan Claims & Medicaid study of incident AS, PsA, or RA (2010–2017) that Opioid use was highly prevalent in AS (36%), PsA (30%), & RA (44%) in the year prior to Dx & during the 1st Yr. Is this PCP or Rheumatologist mismanagement?
  8. NON-treatment of 18,318 VA pts (RA, SpA, PsA) = 41% not Rx DMARDs w/in 12 mos of Dx. Signif higher odds if Black (HR 1.13), Hispanic (1.14), Charlson Comorbidity ≥2 (1.15), opiate use (1.09). DMARD use ^ if married, w/ erosions, female MD, Rheum Dx
  9. Insurance claims data studied 7580 newly Dx RA (2018-2020) - 1998 tofacitinib vs 5582 adalimumab. After propensity matching, dyslipidemia was signif. higher w/ TOFA (HR 1.25), BUT no differences in MACE (HR 0.995) or all-cause mortality (HR, 1.4; NS)
  10. FAERS retrospective, safety study of JAKi use in 75K RA pts (52K Tofa; 21K Upa, 2.2K Bari vs bDMARDs) found JAKi had incr risk of VTE (adj ROR=2.11), CVA (ROR=1.25), IHD (1.23), edema(1.22), & tachyarrhythmias (1.15)
  11. Disparities in SLE care: adult Medicare cohort study of 1,036 SLE pts found 39% saw a rheumatologist q 6 mos & 28% had serologic tests. Least disadvantaged quintile had higher visit-based retention, but decreased serologic testing (aOR 0.80)
  12. Greek cohort study of 570 SLE pts; lupus nephritis was initial presentation in 59, w/ another 66 LN during F/U (total LN= 22%). Predictors of LN: male sex (adjHR 4.31), Dx age <26yrs (3.71), Hi dsDNA (2.48), low C3/C4 (NS 2.24)
  13. SLE Cost of Care and Disease Activity 
  14. Window of Opportunity in Psoriatic Arthritis 

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