Low Risk of COVID in Biologic Treated Rheum Patients

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In an Annals of Rheumatic Disease report, Italian investigators performed consecutive testing for SARS-CoV-2 (IgM and IgG) between 25 March to 25 May 2020 and compared test results between rheumatic disease (RMD) patients and the general population. 

Rapid Loss of SARS-CoV-2 Antibodies in Mild Disease

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According to a small, observational study out of UCLA published as correspondence in the NEJM on July 21, 2020, those with mild COVID-19 symptoms showed an approximate antibody half-life of 73 days. COVID-19 infection was confirmed by PCR in 30 out of 34 study participants. The remaining four patients developed consistent symptoms and cohabitated with a person who had a known positive test but could not get testing due to availability or mild symptoms.

Higher Rates of SARS-CoV-2 Seropositivity in the USA

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The number of reporting cases of COVID-19 infection tends to underestimate the true prevalence of infection as only the more severe cases (e.g.,acute respiratory syndrome) get tested or go to the hospital. JAMA Internal Medicine reports that a cross-sectional seroprevalence study from the U.S. shows that COVID-19 is underreported and that actual infection rates can be 6 to 24 times more prevalent than currently reported infections due to SARS-CoV-2.

For TNF Response in RA, Weight Matters

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Patients with rheumatoid arthritis (RA) who were obese were significantly less likely to remain on treatment with tumor necrosis factor (TNF) inhibitors -- but so were those who were underweight, a large, long-term study determined. Compared with patients with normal weight, patients in obesity class II, whose body mass index (BMI) was 35 to 39.9, had a hazard ratio for shorter drug survival (i.e., the drug's effectiveness, safety, and tolerability) of 1.28 (95% CI 1.06-1.54), while those in obesity class III, whose BMI exceeded 40, had a hazard ratio of 1.67 (95% CI 1.29-2.18), according to Sytske Anne Bergstra, PhD, of Leiden University Medical Center in the Netherlands, and colleagues.

Steroids and Tocilizumab in Cytokine Storm Syndrome

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A recent study from the Netherlands has shown that patients with severe COVID-19-associated cytokine storm syndrome (CSS)  with high dose steroids and tocilizumab had a faster recovery, less need for invasive mechanical ventilation and fewer deaths when compared to CSS patients receiving supportive care only. They studed COVID-19 patients with CSS, defined as rapid respiratory deterioration plus at least two of the following biomarkers: a) C-reactive protein >100mg/L; b) ferritin >900 µg/L; or c) D-dimer >1500 µg/L.

Risankizumab Outduels Secukinumab in Psoriasis

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The IMMerge trial has demonstrated the superiority of interleukin (IL)‐23 over IL-17A inhibition adults with plaque psoriasis.

RECOVERY Trial: Dexamethasone in COVID-19

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Inflammatory events following infection with SARS-CoV-2 can often worsen the morbid or mortal outcomes with COVID, yet it has been unclear if glucocorticoids may modulate inflammation-mediated damage and lung injury.  The RECOVERY trial reports that dexamethasone (DEX) use lowered 28-day mortality among COVID-19 patients requiring respiratory support. The RECOVERY trial was performed in the UK and enrolled hospitalized COVID-19 patients who were randomly assigned patients to usual care alone or the addition of oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days. The primary outcome was 28-day mortality. 

Meloxicam Superior to Placebo and Cognitive Behavioral Therapy in Knee OA

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Pain management in knee osteoarthritis (OA) is confounded by studies showing less is equal to usual standards of care. A recent trial showed that meloxicam was superior to placebo or cognitive behavioral therap (CBT); although the differences were small. 

Characteristics Underlying Mortal COVID-19 Outcomes

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From January 1, 2020–May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19–associated deaths were reported in the United States.

RheumNow Podcast – LTF – Listen to Fauci (7.17.20)

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Dr. Jack Cush reviews the news, tweets and journal articles from the past week on RheumNow. Let's dig into this week's 14 highlights.

PRIME Cells Predicting Rheumatoid Arthritis Flares

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The current issue of NEJM reports a novel cell type that may be used to identify rheumatoid arthritis (RA) patients who may flare.  Investigators prospectively collected blood samples from 4 patients for longitudinal RNA sequencing (RNA-seq) for discovery of moleculartranscripts that were differentially expressed before flares.

HCQ May Help Prevent Fetal Heart Block

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Hydroxychloroquine (HCQ) helped reduce recurrent maternal autoantibody-mediated congenital heart block (CHB) in fetuses, an open-label study suggested.

Anti-Rheumatic Therapies for COVID-19 Infection

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Since the onset of the COVID-19 pandemic numerous anti-rheumatic therapies have been proposed as being potentially beneficial. The mechanistic effects of these agents, either presumed antiviral, anti-inflammatory and anti-thrombotic effects, may benefit mitigate the damage seen with COVID-19 infection. This review will examine the potential benefits and existing evidence for treating suspected or proven COVID-19 infection with antimalarials, inhibitors of interleukin-6 (IL-6) or interleukin-1 (IL-1) Janus kinase (JAK) inhibitors, TNF inhibitors or colchicine. There are many other antirheumatic and immunosuppressive therapies that are in clinical trials that will not be reviewed here including IVIG, rituximab, calcineurin inhibitors (sirolimus, etc.), apremilast, emapalumab (anti-IFN gamma), etc.

JAK Inhibitor Succeeds as Monotherapy in Rheumatoid Arthritis

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The oral Janus kinase (JAK) inhibitor upadacitinib (Rinvoq) given as monotherapy was more effective than methotrexate alone in methotrexate-naive patients with active rheumatoid arthritis (RA) in a multinational phase III trial.

IL-17 Superior to TNF Inhibition in Psoriatic Arthritis

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A one year head-to-head (H2H) trial has shown ixekizumab (IXE) to be superior to adalimumab (ADA) in psoriatic arthritis (PsA); for both skin and articular outcomes. The SPIRIT H2H study was a 52-week trial of 566 biologic DMARD naive, PsA patients, randomized to received either IXE or ADA. The primary end point was at Wk 24, but the newly published data shows week 52 results for ACR50 and Psoriasis Area and Severity Index 100 responses.