Don’t Hold the JAK (10.9.2026) Save

On this week's podcast, Dr. Jack Cush reviews the news: Steroids are easy to start and hard to stop; hold the MTX but not the biologic or JAK, weighing in on avacopan, and age-old messages for old-age patients. 

1. FDA has approved rembrutinib (Rhapsido - BTK inhibitor from Novartis)as 1st Rx for adults with dermographism not controlled by H1 antihistamines (expanding its use beyond chronic spontaneous urticaria) https://buff.ly/xNfuSlh
2. Merck MSD announced positive results w/ tulisokibart (anti-TL1A) in MK-7240-012, Phase 2b DBRPCT in mod-severe hidradenitis suppurativa. Wk 16 HiSCR50 responses were 72% (hi dose), 64% (mid dose), 52% (low dose) vs 35% PBO. https://t.co/cvBH0fvCnI https://t.co/jo7JaXMItZ
3. Biogen announced the 52 week OL results of AMETHYST Phase 2/3 RCT of litifilimab in 93 #CLE pts. Betw wk 24 & 52, pts improved w/ clear skin (27.2%; CLA IGA 0-1) & 29% CLASI-70 (dz activity) https://t.co/61zxVhUwuj
4. Argenx announced it will discontinue its phase 3 UNITY study -efgartigimod SC in adults with mod-to-severe Sjögren's dz, based on not meeting its primary endpoint (clinESSDAIwk 48) & rec from DSMB. ""Sjögren's Disease is one of the most heterogeneous and complicated diseases in immunology” https://t.co/fmuzxvaCGx
5. Retrospective Kuwait registry study of 2629 RA pts- 2326 (88.5%) w/ early (EORA) vs 303 (11.5%) late(LORA). LORA had more age related comorb. Dz (2 vs. 0.9), similar DAS28/CDA, but signif higher ESR (41 vs 33). T2T applies regardless of age!! https://buff.ly/RS4sd4h
6. Multicenter retrosp study 2865 #RA pts (dz duration 2 yrs) starting b/tsDMARDs (TNFi, IL-6i, RTX, ABA, JAKi) - 50% were on steroids (GC). At 3 & 6 mos, only 26% & 37% D/C GC. GC D/C more w/ JAKi (24 v 17%). Predictors on NON-D/C: Chronic GC, HTN, TNFi, RTX, ABA (vs JAKi) https://t.co/JSve6M9hwm
7. T-cell engager blinatumomab (CD3xCD19 TCE) was used for Deep B-cell depletion in 15 resistant RA pts (MDR-RA). @wk 12 9/15 CDAI LDA, 3/15 CDAI remission. Synovial B cells were depleted (4 of 5 biopsies) but not in lymph nodes. Later, 14/15 flared. No ICANs, 3/15 w/ CRS (gr 1) https://t.co/ddLb7lIHka
8. Metanalysis of IVIG in scleroderma (11 studies, 363 pts) showed IVIG to be safe; signif improvement in skin by mRSS (SMD −0.59; p 0.0019) & GI Dz (SMD −0.73; p 0.0012; I2 = 0%). W/ inflam myopathy signif reduction in CK (SMD −0.53; p<0.001) https://t.co/h53FrACCgA&nbsp;https://t.co/qavoD3Vren
9. 2 cohorts of GC naive, suspected (n 185) PMR pts studied with MSK ultrasound - 67% Dx w/ PMR clinically. No single MSK US finding was ound pathognomonic for PMR. Best specificity (85-93%) was 1+ inflammatory lesion in both the shoulder & hip girdles https://t.co/XOXGeTBl5m
10. Danish national study (2003-2024) of 51,401 #PMR pts (24K PCPs, 27K secondary MDs): PMR incidence = 112/100K. PMR decr 53% in primary care & incr 30% in secondary care (overall 12% decline). Among PMR, GCA rate was 5.4/1,000 PYs, w/ median 68 days from PMR Dx. 28% & 22% were still on PDN after 5 & 10 yrs were https://t.co/1VlI5r1r0L
11. Italian retrospective study of 36 difficult #GCA pts (89% relapsed; 72% prev TCZ) Treated with Secukinumab showed Clinical remission 85%, 81%, & 83% at 3, 6, & 12 mos. GC-free remission increased to 15%, 28%, & 40% at 3, 6, & 12 mos. GCs d/c in 43%. Results at odds w/ ph III GCAptAIN RCT where SEC failed to meet its endpoint https://t.co/ufCeaJnVXk
12. 43 biopsy-proven Giant cell arteritis in Black Caribbeans - GCA incidence rate 1.76/100K pY (1/2 rate of whites) w/ 4 fold incr betw 1993 & 2014. Mean Age 76; F:M ratio 4.4. Initial Sxs HA (65%), jaw claud (33%), scalp tender (37%), anterior ischemic optic neuropathy (26%) & PMR (33%). Mean survival was 13 yrs https://t.co/lHAeNdOqbj
13. Retrospective real world avacopan (AVCP) safety data from UK vasculitis center looked at AAV pts (RTX or CTX) rx w/ AVCP (n 133) or not AVCP (n 458). @1 yr AVCP had nonsignif incr in ALT >2xULN (15.8% v 11.4%) or >3xULN (11.3% v 6.3%; P 0.064) No diff in Alk phos, Bili, Hy's law https://t.co/ZZhpxdKhQl
14. Retrospective cohort study of 387 ANCA-assoc. vasculitis pts Rx w/ GC +/- avacopan (AVA 52 vs 335 not Rx AVA). AVA use assoc w/ signif less severe infx (adj HR 0.22), & less pred use - but no diff in relapse risk was observed. https://t.co/GTtAf7KiqB
15. Study of 64 Stills related #MAS pts (55 sJIA; 9 AOSD). All Rx GCs; 75% anakinra, 52% ciclosporin. Complete remission in 7, partial Rem in 64%; GCs tapered in 78% in median 40d. MAS recurred in 31%; 11% died; 1-year survival probability 93.75% https://t.co/HxhhpRsSMO
16. Serum Abs against IL-1 recept antagonist (aIL-1Ra) were studied in 46 adult-onset Still’s Dz (AOSD not on anakinra) pts & found signif. higher in AOSD vs controls (p=0.003); but levels did not differ between active vs inactive AOSD https://t.co/w6KvLyv1j8
17. Triple Hormone Receptor Agonist for Treatment of Obesity and Knee Osteoarthritis
18. Don't Hold the Biologic or JAK with COVID-19 Vaccination