RheumNow Week In Review - 20 October 2017 Save
RheumNow Week In Review - 20 October 2017 by Dr. Cush
Transcription
Hi, I'm Doctor. Jack Cush, executive editor of roomnow.com. It's the October 20, and this is the room now we can review. I'm coming to you this week from Dubai and half hour twenty seventeen. Meeting just concluded.
It was a full week from Monday to Friday of presentations. They had almost 2,000 people here. A really well run meeting. I'll stop with the start with some information from this meeting. I attended many good lectures.
Ian McGinnis was great. Johannes Bilsma was great. Michelle Petrie was great. I always liked it when Munter Kamashta talks about antiphospholipid syndrome. You know, he worked with Ron Asherson and many others in the field and is a leader in the field.
He did a nice review, spoke of a registry of catastrophic anti phospholipid patients and really was able to shed light on the problem. What he did show was that, amongst patients with anti phospholipid syndrome, only zero point eight percent will develop the catastrophic anti phospholipid syndrome where there's organ system involvement, small vessel disease, and a positive serologies to indicate the diagnosis. Many of the features that he talked about included that, this tends to be a disease and a disorder that affects small vessels and skin but likes to affect intra abdominal organs, almost preferentially as highest on the list, pulmonary, and the chest cavity being second most common. One of the big issues that he did cover was that many of these events are triggered by infections. It's not clear why that is, and, but they did, present data that showed that may be that there's molecular mimicry.
Patients who did have, infectious induced, catastrophic antiphospholipid syndrome often had evidence of peptides that were cross reactive with beta two glycoprotein, and that sort of again fits in with theory of molecular mimicry. Deaths are going down in the syndrome. The syndrome has a high mortality rate, and it used to be it was fifty percent, it's now down to thirty seven percent presumably with more effective diagnosis and treatment. So that's it for the catastrophic anti phospholipid syndrome. We have a lot of other news on the website this week.
A long term study of RA patients, followed for almost seven years, it was shown that, nearly sixty five percent of patients were taking low dose prednisone with an average dose of three point one milligrams per day. And that such patients, those that were on steroids, were more likely to have been on, nonsteroidals, DMARs, biologics, have greater disease activity, higher CCP levels, and CCP positivity suggesting that this tends to be something seen in patients with more aggressive disease and prednisone becomes one of several regimens that are employed in the management of such patients. News from the FDA, last week was that, a few weeks ago was that, cirucoumab, an IL-six inhibitor in development by Janssen was turned down. They received a complete response letter. Janssen this week halted its IL-six development program, citing the FDA rejection the need for additional clinical evidence that really would make the development of the drug costly, expensive, delayed, not necessary in the current environment.
An interesting report in adult rheumatic disease talked about the use of abatacept, a pilot trial in those who have I want to make sure we're still going here. In those who had refractory disease. And it was shown that of those received IV abatacept, we have either dermatomyositis or polymyositis, half of them were improved and that when they did muscle biopsies, they did show the presence of FOXP3T regulatory cells suggesting a clinical and a biologic effect in such patients. A review of, this is a little older citation, I put it up because I was covering psoriasis and psoriatic arthritis found that, psoriasis affects, between one point four and three point three percent of the patients. It's estimated that nearly half the patients are not seeing an MD and that nearly half the patients stop their biologic therapy for safety or for no effect.
Again, the incidence of psoriatic arthritis amongst patients with psoriasis has always been reported as being five to forty percent, but there are consistent data now showing, multiple studies showing that the real rate seems to be about thirty percent of those who have psoriasis will get psoriatic arthritis. A new report will appear this week in New England Journal about tofacitinib being effective in patients who have TNF inhibitor resistant psoriatic arthritis. This is a win for the drug. This is part of the data, which is the OPWL study that was presented to the FDA that led to unanimous vote suggesting approval to the FDA. It is likely this drug would be approved sometime before the end of the year.
The data in this particular trial showed that response rates were twenty four percent at three months for placebo, five milligram BID was fifty percent and ten milligrams BID was forty seven percent, and the other primary endpoint was met with a significant decrease in HAC DI over time. An interesting report appeared yesterday in our RheumNow website that showed that rheumatologists are very slow to respond, with DMAR changes to those who have manifest high or moderate disease activity. In a fairly large cohort, it was shown that the percentage of patients who had moderate to high disease activity who had a change in their DMARDs was only sixty percent after ninety days or three months. That the number went up, a little bit more when you go out to one hundred and fifty four days, but again, there's significant delay, in the need for new therapy, the change in therapy. The time to achieve LDAS in these patients was a three zero one days.
Again, very disappointing. So, a paper that we have impressed myself, Jeff Curtis, a few others looks at how we measure and our study showed that more than half of rheumatologists do some sort of measure in their practice, with almost thirty percent doing a Rapid three, somewhere around ten percent to twelve percent doing a Vectra, and you know, again, we measure but obviously data like this says that we don't do anything with the measure. And this is disappointing and there's a really, this is a large unmet need in rheumatoid arthritis. There's also data this week about drug discontinuation rates and non adherence in fibromyalgia. That may not come as a surprise to many of you, but sixty percent of patients were classified as being poorly adherent, meaning that they spent less than 20% of their days being covered by the medication that was prescribed.
When they looked at the non adherence rates, it ranged from seventy to ninety percent. Looking at a lot of the drugs that we use in treating fibromyalgia including SSRIs and tricyclic antidepressants. The number of people who are very adherent with greater than 80% refills on their drugs was only nine point three percent. This is a major challenge. The last item on our news for this week is for those of you going to San Diego, there is an outbreak of hepatitis A in San Diego.
There's been over nine hundred hepatitis A reports and so far eighteen deaths associated with hepatitis A in San Diego. A lot of these come from patients who are homeless and patients some some of these are people who are in the food industry. If you haven't been vaccinated, it's something it's about right now on the verge of being possibly efficacious because the vaccination will require two to four weeks to have adequate immune responses to the vaccine. But this is an issue as we head our head our way to San Diego and the ACR twenty seventeen meeting. That's it for RheumNow this week.
Tune in to the website for more news. We'll see you next week. Take care.
It was a full week from Monday to Friday of presentations. They had almost 2,000 people here. A really well run meeting. I'll stop with the start with some information from this meeting. I attended many good lectures.
Ian McGinnis was great. Johannes Bilsma was great. Michelle Petrie was great. I always liked it when Munter Kamashta talks about antiphospholipid syndrome. You know, he worked with Ron Asherson and many others in the field and is a leader in the field.
He did a nice review, spoke of a registry of catastrophic anti phospholipid patients and really was able to shed light on the problem. What he did show was that, amongst patients with anti phospholipid syndrome, only zero point eight percent will develop the catastrophic anti phospholipid syndrome where there's organ system involvement, small vessel disease, and a positive serologies to indicate the diagnosis. Many of the features that he talked about included that, this tends to be a disease and a disorder that affects small vessels and skin but likes to affect intra abdominal organs, almost preferentially as highest on the list, pulmonary, and the chest cavity being second most common. One of the big issues that he did cover was that many of these events are triggered by infections. It's not clear why that is, and, but they did, present data that showed that may be that there's molecular mimicry.
Patients who did have, infectious induced, catastrophic antiphospholipid syndrome often had evidence of peptides that were cross reactive with beta two glycoprotein, and that sort of again fits in with theory of molecular mimicry. Deaths are going down in the syndrome. The syndrome has a high mortality rate, and it used to be it was fifty percent, it's now down to thirty seven percent presumably with more effective diagnosis and treatment. So that's it for the catastrophic anti phospholipid syndrome. We have a lot of other news on the website this week.
A long term study of RA patients, followed for almost seven years, it was shown that, nearly sixty five percent of patients were taking low dose prednisone with an average dose of three point one milligrams per day. And that such patients, those that were on steroids, were more likely to have been on, nonsteroidals, DMARs, biologics, have greater disease activity, higher CCP levels, and CCP positivity suggesting that this tends to be something seen in patients with more aggressive disease and prednisone becomes one of several regimens that are employed in the management of such patients. News from the FDA, last week was that, a few weeks ago was that, cirucoumab, an IL-six inhibitor in development by Janssen was turned down. They received a complete response letter. Janssen this week halted its IL-six development program, citing the FDA rejection the need for additional clinical evidence that really would make the development of the drug costly, expensive, delayed, not necessary in the current environment.
An interesting report in adult rheumatic disease talked about the use of abatacept, a pilot trial in those who have I want to make sure we're still going here. In those who had refractory disease. And it was shown that of those received IV abatacept, we have either dermatomyositis or polymyositis, half of them were improved and that when they did muscle biopsies, they did show the presence of FOXP3T regulatory cells suggesting a clinical and a biologic effect in such patients. A review of, this is a little older citation, I put it up because I was covering psoriasis and psoriatic arthritis found that, psoriasis affects, between one point four and three point three percent of the patients. It's estimated that nearly half the patients are not seeing an MD and that nearly half the patients stop their biologic therapy for safety or for no effect.
Again, the incidence of psoriatic arthritis amongst patients with psoriasis has always been reported as being five to forty percent, but there are consistent data now showing, multiple studies showing that the real rate seems to be about thirty percent of those who have psoriasis will get psoriatic arthritis. A new report will appear this week in New England Journal about tofacitinib being effective in patients who have TNF inhibitor resistant psoriatic arthritis. This is a win for the drug. This is part of the data, which is the OPWL study that was presented to the FDA that led to unanimous vote suggesting approval to the FDA. It is likely this drug would be approved sometime before the end of the year.
The data in this particular trial showed that response rates were twenty four percent at three months for placebo, five milligram BID was fifty percent and ten milligrams BID was forty seven percent, and the other primary endpoint was met with a significant decrease in HAC DI over time. An interesting report appeared yesterday in our RheumNow website that showed that rheumatologists are very slow to respond, with DMAR changes to those who have manifest high or moderate disease activity. In a fairly large cohort, it was shown that the percentage of patients who had moderate to high disease activity who had a change in their DMARDs was only sixty percent after ninety days or three months. That the number went up, a little bit more when you go out to one hundred and fifty four days, but again, there's significant delay, in the need for new therapy, the change in therapy. The time to achieve LDAS in these patients was a three zero one days.
Again, very disappointing. So, a paper that we have impressed myself, Jeff Curtis, a few others looks at how we measure and our study showed that more than half of rheumatologists do some sort of measure in their practice, with almost thirty percent doing a Rapid three, somewhere around ten percent to twelve percent doing a Vectra, and you know, again, we measure but obviously data like this says that we don't do anything with the measure. And this is disappointing and there's a really, this is a large unmet need in rheumatoid arthritis. There's also data this week about drug discontinuation rates and non adherence in fibromyalgia. That may not come as a surprise to many of you, but sixty percent of patients were classified as being poorly adherent, meaning that they spent less than 20% of their days being covered by the medication that was prescribed.
When they looked at the non adherence rates, it ranged from seventy to ninety percent. Looking at a lot of the drugs that we use in treating fibromyalgia including SSRIs and tricyclic antidepressants. The number of people who are very adherent with greater than 80% refills on their drugs was only nine point three percent. This is a major challenge. The last item on our news for this week is for those of you going to San Diego, there is an outbreak of hepatitis A in San Diego.
There's been over nine hundred hepatitis A reports and so far eighteen deaths associated with hepatitis A in San Diego. A lot of these come from patients who are homeless and patients some some of these are people who are in the food industry. If you haven't been vaccinated, it's something it's about right now on the verge of being possibly efficacious because the vaccination will require two to four weeks to have adequate immune responses to the vaccine. But this is an issue as we head our head our way to San Diego and the ACR twenty seventeen meeting. That's it for RheumNow this week.
Tune in to the website for more news. We'll see you next week. Take care.
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