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Best Rheumatologists (7.19.2024)

This week on the RheumNow Podcast, Dr. Jack Cush reviews the news and journal reports of interesting, including irAE, pollution and Psoriasis, microwave therapy, scleroderma without scleroderma that only the best rheumatologists could discern.

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IL-17 inhibitor Brodalumab is not often talked about, but its approved for PsO & PsA. German study of 227 PsO w/ 37 PsA pts Rx w/ BRO - good, rapid response by 3 mos. 1 year drug survival rate was 76.2%, (mean discontinuation=8.3 mos. https://t.co/4byFoc96Zs https://t.co/sPomX0s8aa
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Updated EULAR Recommendations on the Treatment of Systemic Sclerosis Medscape has published an overview to the 2024 updated recommendations for the treatment of SSc presented in Vienna at EULAR 2024. https://t.co/U0usOgajFQ https://t.co/Hos3mu7rVE
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IRIS-RA, a failed phase 2 study of Nipocalimab, an anti-FcRn mAb severe active RA not responding to TNFi. 53 seropos. RA pts did not achieve primary endpt of better DAS28-CRP at Wk 12 (but Nipo was numerically better & signif lowered RF, CCP, but not CRP) https://t.co/52HLsfpKLS https://t.co/eEifXA6MpP
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Medscape review of new Gout research from EULAR 2024 - Phase 3 trial program for SEL-212 - Safety of SEL-212 - New Selective URAT1 Inhibitors - ruzinurad & AR882 https://t.co/szVRO2sqpu https://t.co/B9LcdpeCGd
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Updated EULAR Recommendations on the Treatment of Systemic Sclerosis

Medscape

Medscape has published an overview to the 2024 updated recommendations for the treatment of systemic sclerosis (SSc) presented in Vienna at EULAR 2024 by Professor Francesco Del Galdo, MD, PhD on behalf of a 27 member task force.

The new recommendations (n=20)

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Does B Cell Depletion Matter? Dr. Yuz Yusof interviews Dr. Ed Vital regarding abstract OP0077 at Eular 2024 in Vienna, Austria. https://t.co/SX7BkX3w1T https://t.co/H1rD0n8GnK
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AbbVie has submitted regulatory applications to both the FDA and the European Medicines Agency for Rinvoq (upadacitinib) to treat adult patients with giant cell arteritis (GCA) https://t.co/LqRcm2FEFV https://t.co/XEjjSNnOGt
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Efficacy of Biologics in Patients with CKD A retrospective cohort study of biological bDMARDs persistence in RA patients w/CKD, shows the 3 year survival to be > 50% but all studied biologics were nearly equivalents with regard to safety and efficacy. https://t.co/rL2ZondUsE https://t.co/1hM237Jl83
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FDA adverse event study of JAKi in #RA assoc w/ signif more VTE, ischemic heart Dz, & tachyarrhythmias. 75,407 on JAKi vs 303,278 on biologics (TNFi, RTX, TCZ); JAK had more VTE (ROR=2.11), CVA (ROR=1.25), IHD (1.23), arrhythmias (1.15 ), esp in 1st yr. https://t.co/IVsGwqpiJK https://t.co/4epOHdNHbO
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Sobi has submitted a biologics license application to FDA for SEL-212 (pegadricase a uricase enzyme that breaks down uric acid) based on DISSOLVE I & II RCTs. SEL-212 was given FDA FDA’s Fast Track designation in March 2024 https://t.co/TPcUnCJOxT https://t.co/X1DrFDJZeK
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European Research Council has awarded a Proof of Concept Grant to Institute of Bioengineering of Catalonia and their OrthoBots project, to study the treatment of joint diseases using nanorobots to deliver nanoparticle based therapy to synovial tissues https://t.co/JmYQ1727rf https://t.co/k5uZoSwJPo
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Progress in SLE with new mRNA CAR-T cell Trial Cartesian Therapeutics, has announced their first-in-class mRNA CAR-T therapy has been given to the first SLE. patient in a Phase 2 open-label clinical trial. https://t.co/7SYNtjIn9F https://t.co/a5LJn8QLT3
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Pollution and Autoimmunity (7.12.2024)

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

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MTX was tapered or D/C in 30% of RA pts w/in 2 yrs of b/tsDMARD Rx. Of 889 pts, MTX (19 mg/wk) tapered in 13.8% & D/C 16.5% (planned taper(37%); pt decision (27.2%). In 582 (66%) MTX unchanged, 4.25 increased MTX after b/tsDMARD initiation https://t.co/yc8exMbeD1 https://t.co/b3L3Fha7xU
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Bimekizumab (dual-IL-17A/F inhib), may prevent uveitis in patients with axSpA. In phase 3 RCTs (MOBILE 1 & 2) double-blind period, uveitis seen in 0.6% on BKZ vs 4.6% on PBO (p=0.001). In pts w/ hx uveitis, again lower w/ BKZ (6.2/100 PYs vs 70.4/100 PYs) https://t.co/v0wMK45chz https://t.co/CVPdg1k41V
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PNAS & Nature Insights into Lupus Pathogenesis

Two prominent medical journals this week published new insights into the pathogenesis of systemic lupus erythematosus (SLE), with both inidicating promient roles for T cells in what is a classically viewed as a humoral (B cell) disorder. 

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Cost-Effectiveness of Biosimilars vs Leflunomide An economic evaluation of 25 099 rheumatoid arthritis patients found that treatment with biosimilar DMARDs were cost-effective compared with the conventional DMARD, leflunomide. https://t.co/lWJB1VL1CL https://t.co/lzra8suVqs
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Paradoxical psoriasis w/ IL-17 inhib? Lit review 35 (SpA) pts, presenting as palmoplantar pustular and plaque PsO; median 11 weeks after IL-17i. one-third continued IL-17i w/ mostly topical Rx; 2/3 D/C IL-17i, switching to other biologic w/ good outcomes https://t.co/q2xqQyiM3b https://t.co/6hSE6NLHWw
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Efficacy of Biologics in Patients with Chronic KIdney Disease

A retrospective cohort study of biological disease-modifying antirheumatic drugs (bDMARDs) persistence in rheumatoid arthritis (RA) patients with chronic kidney disease (CKD), shows the 3 year survicval to be under 50% but that all studied biologics were nearly

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CT angio in 75 pts w/ Takayasu arteritis (40 w/ cDMARDs, 35 biologics) showed reduced arterial thickness in 73% (31% w/ >25% decr in wall thickness). 1st immunosuppressives (p= 0.012) & bDMARDs(p= 0.026) reduced art. wall thickness (relative to cDMARDs) https://t.co/16eGmgVoWr https://t.co/AyNyT7FsYZ
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FDA adverse event study of JAKi in #RA assoc w/ signif more VTE, ischemic heart Dz, & tachyarrhythmias. 75,407 on JAKi vs 303,278 on biologics (TNFi, RTX, TCZ); JAK had more VTE (ROR=2.11), CVA (ROR=1.25), IHD (1.23), arrhythmias (1.15 ), esp in 1st yr. https://t.co/BmNPk6zN6o https://t.co/fbzHQmPmH5
Dr. John Cush @RheumNow( View Tweet )

Cost-Effectiveness of Biosimilars vs Leflunomide

An economic evaluation of 25 099 rheumatoid arthritis patients found that treatment with biosimilar disease-modifying antirheumatic drugs (DMARDs) were cost-effective compared with the conventional DMARD, leflunomide. Does this suggest RA treatment guidelines need to be amended to allow

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RT @drdavidliew I have to say: upadacitinib looks very decent for GCA. Not a panacea, but it definitely does something & good safety during trial. Would love to eventually see: - H2H comparative effect vs toci, secukinumab - structural outcomes - long-term safety #EULAR2024

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ICYMI: 2023 EULAR Psoriatic Arthritis Recommendations

EULAR has updated its treatment recommendations from the prior 2019 guidelines, since there have been several newly developed agents. The updated guidance includes 7 overarching principles and 11 recommendations regarding treatment strategy and pharmacological therapies.

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