Is IL-23 Better than IL-17 Inhibition in Psoriasis?

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Data presented at the recent American Academy of Dermatology meeting suggests that interleukin (IL)-23 inhibition with risankizumab was more effective than the IL-17 inhibition (secukinumab) based on a 52 week randomized head-to-head trial in moderate to severe psoriasis patients.

Tocilizumab May Benefit COVID-19 Pneumonia

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A retrospective, observational study published in Lancet Rheumatology has shown that tocilizumab (TCZ) may reduce the risk of death or the need for mechanical ventilation in severe COVID-19 pneumonia. This observational study included adults, with severe COVID-19 pneumonia, who were hospitalized between Feb 21 and March 24, 2020. All were on the standard of care (ie, supplemental oxygen, hydroxychloroquine, azithromycin, antiretrovirals, and low molecular weight heparin), and a non-randomly selected subset of patients also received TCZ.

RheumNow Podcast – Lupus Mortality Declines, But… (6.26.20)

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Dr Jack Cush reviews the news and journal articles from the past week on RheumNow.com

Protective Benefit of Colchicine in COVID-19 Infection

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Colchicine has been advocated as a potential anti-inflammatory intervention in patients with the coronavirus 2 infection and clinical trials have been developed to assess its effect in early COVID-2 infection.  JAMA has published a randomized clinical trial showing that low dose colchicine had less clinical deterioration without significant changes in biomarkers, such as high-sensitivity cardiac troponin and C-reactive protein.

ACR Outlines Best Practices for Kids With MIS-C

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Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection has both similarities and differences with Kawasaki disease, and requires distinct clinical management, according to draft guidance from the American College of Rheumatology (ACR).

TNFi Cycling vs. Swapping Biologics in Rheumatoid Arthritis

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For years, rheumatologists would rather fight to stay on a TNF inhibitor (TNFi) than switch to a non-TNFi biologic when rheumatoid arthritis (RA) therapy fails.

Mortality in Lupus Declines between 2006 and 2016

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The largest study, to date, shows that in‐hospital mortality of systemic lupus erythematosus (SLE) patients has significantly improved between 2006 and 2016, with a high mortality burden among U.S. Blacks and Hispanics with lupus.

Adverse Events With Rheum Biologics Rise With Age

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Among patients with rheumatic diseases, age and female sex were important factors associated with the development of a first adverse event after initiating biologic treatment, Spanish researchers reported.

Hydroxychloroquine Fails as Postexposure Prophylaxis for Covid-19

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Add this to the list of hydroxychloroquine (HCQ) letdowns in managing COVID-19 treatment or risk - prophylaxis with HCQ fails to prevent COVID-19 infection in those exposed to the SARS-CoV-2 virus.  NEJM has reported a prospective, randomized, double-blind, placebo-controlled trial from the US and Canada wherein adults with household or occupational exposure to someone with confirmed Covid-19 were treated with either placebo or HCQ within 4 days of exposure.

Upside Down with Tocilizumab in COVID-19

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Several recent reports offer conflicting views on the potential benefits and adverse outcomes of IL-6 inhibition with tocilizumab (TCZ) therapy in patients with severe COVID-19 infection. An Italian study grabbed the headlines yesterday with a press release stating TCZ did not improve respiratory symptoms, ICU admissions or mortality rates when given to 126 COVID patients with early disease. The study, supported by the Italian Medicines Agency (Aifa), stopped enrollment (about 1/3 of projections) after an interim analysis found insufficient evidence that TCZ would be effective.  This report has not been published or undergone critical review.

RheumNow Podcast – Enough Already with Weaning (6.19.20)

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Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com.

Cosentyx FDA Approval for Non-Radiographic Axial Spondyloarthritis

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Yesterday the FDA approved secukinumab (Cosentyx) for the treatment of patients with active non-radiographic axial spondyloarthritis (nr-axSpA). There are now three agents that are FDA approved for nr-axSpA: certolizumab, ixekizumab and now, secukinumab. 

Voclosporin Beats Standard of Care in Lupus Nephritis

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The high potency calcineurin inhibitor voclosporin plus standard of care was superior to standard of care alone in a phase III study of lupus nephritis known as AURORA.

Canakinumab First FDA-Approved Therapy for Adult-Onset Still's Disease

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Yesterday, the FDA approved canakinumab (Ilaris) as treatment for adult-onset Still's disease (AOSD), the first ever FDA approved drug for AOSD. Canakinumab, an interleukin-1 inhibitor, was FDA approved in 2013 for use children (aged 2 years and older) with systemic juvenile idiopathic arthritis and has since been approved for use in other periodic fever disorders (e.g., FMF, CAPS, TRAPS, Hyper IgD syndrome).

Dexamethasone Reduces Mortality in Severe COVID

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Preliminary results released today shows dexamethasone (DEX), given to hospitalized, severly ill, COVID-19 patients, is capable of reducing mortality rates by one-third, with researchers calling this a “major breakthrough” in coronavirus management. The results stem from a UK trial, called the RECOVERY trial, launched in March 2020, compared outcomes of around 2100 patients who were randomly assigned to DEX treatment compared with 4,300 patients not on DEX.