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Drug Safety

CD19 CAR T-Cell Therapy in Autoimmune Disease

Feb 22, 2024

The NEJM has published the results of CD19 B cell depletion (by CAR-T cell therapy) in autoimmune disease patients, demonstrating it to be feasible, safe, and efficacious.



The rationale to CD19 CAR-T cell transfer is to reset aberrant autoimmunity via deep depletion of B cells with

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ARIAA Trial: Abatacept Delays the Onset of RA

Feb 20, 2024

The ARIAA trial tested the utility of IV abatacept in individuals ACPA+ arthralgia patients with subclinical inflammation and showed abatacept to decrease MRI inflammation, clinical symptoms, and risk of future rheumatoid arthritis (RA) development.

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Retro study of 1,169 pts (age 66 yrs) receiving intra-articular steroids & changes on A1C. A1C increases were assoc w/ higher baseline A1C (OR 1.84) for A1C 7–8 (vs <7%) or A1C >8% (OR 4.8 ). YET most patients do not experience increase A1C after IACS https://t.co/eWyO0nHgdy https://t.co/4UQRbrUyz7
Dr. John Cush @RheumNow( View Tweet )
Feb 17, 2024
Brazilian registry of 1316 RA pts on bDMARDs or JAKi-Added use of antimalarials reduced SAEs & total AEs, & incr survival. 19% were on HCQ, & had signif less SAEs (mIRR: 0.49); AEs (0.68); serious infections (0.53); hepatic AEs (0.21); & mortality (P=.003) https://t.co/bAZ8m3OBo2 https://t.co/SlneyfbJIh
Dr. John Cush @RheumNow( View Tweet )
Feb 17, 2024
Ixekizumab Safety from 25 RCTs (17 PsO, 4 PsA, 4 axSpA) w/ 9225 pts (22371 PYs use). Long-term safety c/w earlier reports/PI. SAEs in 1204 (13%); 45 deaths); ISRs 5.9-11.6/100PYs; IBD ≤ 0.8/100PY; depression, CVA, Cancer : ≤ 1.6/100PY https://t.co/p7N6ZMVvqh https://t.co/22WYkevhaf
Dr. John Cush @RheumNow( View Tweet )
Feb 16, 2024
An updated medication list for diabetes medications with Dr. O. Troum at #RWCS24 @RheumNow @RWCSmtg https://t.co/ZYr5i7PAI9
Dr. Rachel Tate @uptoTate( View Tweet )
Feb 16, 2024

Curbside Consults (2.16.2024)

Feb 16, 2024

Dr. Jack Cush answers audience clinical case questions sent by email or "ask Cush anything". Cases and questions from:



  • Dr. William Hong - RA management in the setting of active TB or latent TB (LTBI)

  • Dr. Vrishali Dalvi - relapsing polychondritis monitoring

  • Dr
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APIPPRA Trial: Abatacept in at-risk rheumatoid arthritis patients

Feb 15, 2024

Abatacept has been studied in seropositive clinically suspect arthralgia patients (at risk for rheumatoid arthritis) and shows the potential to delay or prevent the disease. 



Individuals with serum antibodies to citrullinated protein antigens (ACPA), rheumatoid factor, and arthralgia

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Sex Disparities in PsA/SpA

Feb 13, 2024

Dr. Eder delivered an illuminating talk at RheumNow Live 2024 on sex differences in psoriatic arthritis; the disease may manifest differently in men and women, and therapeutic responses may differ between the sexes.

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JAKi Rx pts w/ H.Zoster who continue JAKi are not at higher risk for recurrent HZ. 3947 (RA>UC pts on JAKi, 611 had HZ (8.38/100PY). 460 continued JAKi, 78 D/C. Recurrent HZ reactivation. after median 1.1 yrs was 5.3/100 vs. 5.9/100 PY; P = 0.52) https://t.co/FH0ysEkGiA https://t.co/lOHyaXzAn3
Dr. John Cush @RheumNow( View Tweet )
Feb 12, 2024

Co-management of Psoriatic Disease

It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning

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Full read, review of COLCHICINE, a, w/ narrow therapeutic index, & assoc. w/ overdose & fatalities. Discuss Interactions, unauthorized access, overdoses, inappropriate dosing. No dose adjustments w/ Liver dz, but modest changes w/ severe CKD, dialysis https://t.co/53aOA4uqdY https://t.co/fuEwWsXMZG
Dr. John Cush @RheumNow( View Tweet )
Feb 11, 2024

Oral IL-23 Inhibitor Effective in Psoriasis

Feb 09, 2024

The NEJM has published the results of the FRONTIER 1 trial demonstrating the efficacy of JNJ-77242113, an oral interleukin-23 (IL-23) receptor antagonist peptide, in patients with psoriasis (PSO). 



This phase 2 dose-finding trial randomized 255 PSO patients, with moderate-to-

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VITAL Info on Autoimmune Disease (2.9.2024)

Feb 09, 2024

Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".




  1. Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts,

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Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts, 68% Rx low-dose GCs (32% no GCs). After 3 yrsof b/tsDMARDs, 32% still on GCs, 23% D/C GCs, & 20% go on & off, 25% never took GCs. GCs use assoc w/ HTN (20 v 11%) & MI (2.3% vs 0) https://t.co/lWVfvJrAyp https://t.co/uTIWqDAjRG
Dr. John Cush @RheumNow( View Tweet )
Feb 08, 2024

Poly-Refractory Rheumatoid Arthritis

Feb 08, 2024

Refractory of difficult to treat (D2T-RA) rheumatoid arthritis (RA) comprises a minority of patients that can be categorized by clinical and imaging parameters to formulate a better therapeutic approach. 



A cross-sectional study of 1,591 RA treated with b/tsDMARDs were categorized as

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Determinants of Gout Flares

Feb 06, 2024

Approximately 12 million US adults in the US have gout. Two recent literature reports highlight contributors to gout flares.



In JAMA, a retrospective review of 3613 gout patients with 3104 gout flares over 8.3 years showed an expected high rate of gout flares with higher baseline

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Korean Database study of 1796 #AS pf (vs 7184 controls 1:4 ratio); 9.3% develeoped cancer; AS pts have no overall increase in cancer risk (aHR 1.1); AS pts had higher risk ofupper GI cancer (HR: 1.51) & hematologic CA (aHR: 2.36). Is there an NSAID effect? https://t.co/6W68upVQrn https://t.co/RWlhLFV9EJ
Dr. John Cush @RheumNow( View Tweet )
Feb 05, 2024
Since April 2017, DEA Take Back (drugs) campaign has spread to 17,000 locations where your patients can safely dispose of narcotics or unsafe drugs. Find your Everyday Drop-Off center by clicking here: https://t.co/uZPtFtXk6a https://t.co/dRalITYyfV
Dr. John Cush @RheumNow( View Tweet )
Feb 05, 2024

Pre-Treatment Testing with Biologics Falls Short

Feb 01, 2024

US commercial insurance claim analysis of laboratory screening and monitoring practices in chronic inflammatory skin disease (CISD) patients shows that < 60% received the recommended pretreatment testing when starting systemic immunomodulatory treatment.

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Dupilumab (IL-4/13 Inhib) may cause MSK Sxs. Study of 470 Atopic Dermatitis pts on dupilumab; 36 referred to rheum consult, 26 pts (14M/12F) had US/MRI proven enthesitis, arthritis, or tenosynovitis (16 mild, 4 severe). All responded to NSAID or DUP D/C https://t.co/S3ACOC4xUZ https://t.co/juAYbIxNZ6
Dr. John Cush @RheumNow( View Tweet )
Jan 31, 2024
FDA Safety Warning: denosumab now has a Boxed Warning for risk of severe hypocalcemia in CKD pts taking Prolia (usually seen 2-10 wks post injx). Pts may or may not be symptomatic. CKD pts should have Ca and Creatinine monitored. https://t.co/UMYxjWz9n4 https://t.co/AG5wzBrY1Y
Dr. John Cush @RheumNow( View Tweet )
Jan 29, 2024
Oh, snap! But this is true, a single course rituximab at baseline and none at 6 months (or anything else) as a comparator is just wild in a 12 month trial @EBRheum @RheumNow #RNL2024 https://t.co/wuIkuLzIpg
Richard Conway @RichardPAConway( View Tweet )
Jan 28, 2024
Vedolizumab-induced enthesitis @lihi_eder #RNL2024 @RheumNow 11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis Is this true drug rxn or previously masked by prior meds (TNF)? Usually unilateral +/- oligo, dactylitis Most respond to NSAID or injxn, 27% change Rx

Eric Dein @ericdeinmd( View Tweet )

Jan 28, 2024
MTX and cyclophosphamide are the two drugs @DrCassySims recommends holding during breast feeding in our vasculitis patients. #RNL2024 @RheumNow

Dr. Rachel Tate @uptoTate( View Tweet )

Jan 28, 2024