Drug Safety

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Prophylaxis Against PJP in SLE: I'll Pass

Michael Putman, MD, MSCI

I think we're all somewhat familiar with PJP prophylaxis. This is the thing we do to stop the scary, opportunistic infection that affects people who are immunocompromised. I'm going to start by actually steelmanning the case for doing PJP prophylaxis before I explain why I think you probably

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Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/DNEM32yocL

Links:

Dr. John Cush @RheumNow( View Tweet )
FDA has approved nipocalimab (Imaavytm), a FcRn for use in generalized myasthenia gravis (gMG). It is approved for using in gMG patents who are anti-AChR and anti-MuSK antibody positive adults and pediatric gMG patients aged 12 and older. https://t.co/fYCWuTZ6Uz https://t.co/aSfydBS9xh

Links:

Dr. John Cush @RheumNow( View Tweet )
Stop,pills,water

Stable SLE - Should you Withdraw Immunosuppressant or Glucocorticoids?

Jack Cush, MD

An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in systemic lupus erythematosus (SLE) patients and found that IS withdrawal is noninferior to GC withdrawal in SLE patients in long-

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Very low & very high vitamin D (25/OH) levels assoc w/ adverse pregnancy outcomes - miscarriage (P = 0.0045) & preterm delivery (P = 0.0007). APO were lowest w/ 25(OH)D levels of 40 to 59 ng/mL. Monitor vit D and Rx during SLE pregnancies https://t.co/Z9jEgETqId https://t.co/fJRqD3v7UF

Links:

Dr. John Cush @RheumNow( View Tweet )
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Glucocorticoids in SLE: how to start, how to follow, how to stop

Guillermo Ruiz-Irastorza, MD, PhD

Current guidelines recommend limiting the use of glucocorticoids by coining the new concept of “bridging therapy”, that is, use GCs when the disease is active and get rid of them as soon as you can. This way of thinking is conceptually attractive, however, the formula for translation to real

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DANBIO registry study of 720 RA pts w/ a prior solid cancer (breast, colon. lung, endometrial, melanoma, bladder) in remission who received any biologic DMARD, TNFi or RTX found no incr risk of CA recurrence w/ any bDMARD, TNFi, RTX. Specifically, no incr in breast CA recurrence https://t.co/YJw8qXz1yM
Dr. John Cush @RheumNow( View Tweet )
Japan IORRA RA registry shows from 2011 to 2023, despite better Rx & control & less pred, Fractures went up in RA. From 2011 to 2023- DAS resmission 38 to 65%, bDMARD use 14 to 42%, GC use 38 to 22%, OP Rx 32 to 38%; But all FX incr 47 to 53/1000 Pys. https://t.co/cgz0Gkasai https://t.co/D2Uro7mEAT

Links:

Dr. John Cush @RheumNow( View Tweet )
Immune Checkpoint Inhib causing Myasthenia Gravis w/ poor outcomes - 16 ICI Rx pts (9 Lung CA, 7 other tumors) Dx w/ MG; 11 w/ overlap myositis. Mean onset @ 49d. All Rx wp steroids, 6 immunosuppressives, 5 plasma exchange; only 2 complete resp. 6 deaths re: MG complications https://t.co/re73lh2Xfs
Dr. John Cush @RheumNow( View Tweet )
No Extra Cancer Recurrence Risk with Biologics in RA Rheumatoid arthritis (RA) patients in Denmark with a history of solid tumor cancers, now in remission, faced no greater likelihood of cancer relapse when they were treated with biologic agents, compared with conventional https://t.co/dCspjN2oys
Dr. John Cush @RheumNow( View Tweet )
Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/zeqeYt5ZHq

Links:

Dr. John Cush @RheumNow( View Tweet )
FDA has approved nipocalimab (Imaavytm), a FcRn for use in generalized myasthenia gravis (gMG). It is approved for using in gMG patents who are anti-AChR and anti-MuSK antibody positive adults and pediatric gMG patients aged 12 and older. https://t.co/CaSwCnCK8V https://t.co/A2COjk2hzY

Links:

Dr. John Cush @RheumNow( View Tweet )
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Secondary Benefits to SGLT2 Inhibitor Use in SLE

Jack Cush, MD

An emulation trial of sodium–glucose cotransporter 2 inhibitors (SGLT2i) in systemic lupus erythematosus patients yielded a significantly reduced risk of several cardiorenal complications among patients with SLE and type 2 diabetes.

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Japan IORRA RA registry shows from 2011 to 2023, despite better Rx & control & less pred, Fractures went up in RA. From 2011 to 2023- DAS resmission 38 to 65%, bDMARD use 14 to 42%, GC use 38 to 22%, OP Rx 32 to 38%; But all FX incr 47 to 53/1000 Pys. https://t.co/cgz0Gkasai https://t.co/ziZr3BegDz

Links:

Dr. John Cush @RheumNow( View Tweet )
variety of contraception methods

Contraception in SLE

Lisa Sammaritano MD

Pregnancy in SLE gets a lot of press in the rheumatology literature, and deservedly so, since pregnancy risks can be markedly increased. It was not that many years ago that women with SLE were counseled to avoid pregnancy. As recently as 2004, the maternal mortality rate in SLE was 20-fold

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No Extra Cancer Recurrence Risk with Biologics in RA Rheumatoid arthritis (RA) patients in Denmark with a history of solid tumor cancers, now in remission, faced no greater likelihood of cancer relapse when they were treated with biologic agents, compared with conventional https://t.co/RSLMIFGn4U
Dr. John Cush @RheumNow( View Tweet )
Immune Checkpoint Inhib causing Myasthenia Gravis w/ poor outcomes - 16 ICI Rx pts (9 Lung CA, 7 other tumors) Dx w/ MG; 11 w/ overlap myositis. Mean onset @ 49d. All Rx wp steroids, 6 immunosuppressives, 5 plasma exchange; only 2 complete resp. 6 deaths re: MG complications https://t.co/PUc6kIE7FW
Dr. John Cush @RheumNow( View Tweet )
Rheumatoid,RA,nodules,damage

Complex Evolution of RA Management and Outcomes

Jack Cush, MD

FIRST is a Japanese longitudinal, real-world registry of rheumatoid arthritis (RA) management, and over the last 20 years has shown significantly improved outcomes, yet significant challenges and unmet needs remain.

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EULAR Guidelines on Reproductive Health

MedPage Today

Rheumatology patients considering or actually having babies can safely take most of the medications currently used to treat their conditions, according to an updated guideline from the European Alliance of Associations for Rheumatology (EULAR).

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Study of 104 RA-ILD pts found that (31.7%) RA-ILD patients were ANCA positive (29/31 were p-ANCA+). compared to ANCA neg, ANCA+ RA-ILD had more respiratory Sxs, ANA positivity, worse PFTs, more acute exacerbations of ILD, more bronchietasis & honeycombing https://t.co/vZODUW9tSX https://t.co/zTrdtcc78O

Links:

Dr. John Cush @RheumNow( View Tweet )
RHEUMATOLOGIST SURVEY: Which Lupus patients should undergo renal Bx?

Dr. John Cush @RheumNow( View Tweet )

US- Top Drug Rx Sales in 2024 Semaglutide $54 Billion Tirzepatide $31.7 B Adalimumab $28B Apixaban $26 B Empagliflozin $20.5 B Pembrolizumab $18 B Ustekinumab $17 B Risankizumab $16 B Dupilumab $15.6 B Etanercept $10.1 B Secukinumab $7.7 B Immune globulin $7.1 B Upadacitinib $7 https://t.co/Wjcu7LrTfC
Dr. John Cush @RheumNow( View Tweet )
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FDA Approves Rinvoq for Giant Cell Arteritis

Jack Cush, MD

Based on the results of the SELECT-GCA study, the US FDA has approved upadacitinib (Rinvoq or UPA) for the treatment of adults with giant cell arteritis (GCA), also known as temporal arteritis. This is the 9th FDA approved indication for upadacitinib in the U.S. for use in rheumatology,

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Study of 104 RA-ILD pts found that (31.7%) RA-ILD patients were ANCA positive (29/31 were p-ANCA+). compared to ANCA neg, ANCA+ RA-ILD had more respiratory Sxs, ANA positivity, worse PFTs, more acute exacerbations of ILD, more bronchietasis & honeycombing https://t.co/vZODUW9tSX https://t.co/6WUbSoOyOm

Links:

Dr. John Cush @RheumNow( View Tweet )
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2024 Management of Familial Mediterranean Fever Recommendations

Jack Cush, MD

A EULAR/PReS combined task force has developed recommendations for the management of Familial Mediterranean fever (FMF), the most common monogenic autoinflammatory disease worldwide. These evidence-based recommendations update the 2016 recommendations developed for rheumatologists and other HCPs

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Recent Blogs

Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

Richard Conway, MBBChBAO, PhD
Lungs ILD
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.  Read Post

Advancing PMR

Eric L. Matteson, MD, MPH
Dr. Eric Matteson
Even though polymyalgia rheumatica is not perceived by many physicians as a severe diagnosis, its diagnosis and management actually propose significant challenges. I'd like to talk about those challenges, and what directions our path forward can include to advance our understanding and improve the treatment of patients who have PMR. Read Post
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