TNF inhibitor

NEW EULAR POSTER: Real-world treatment patterns across the first 12 months of first-line advanced therapy in patients with PsA Compare treatment switching across first-line MOAs and treatments. Sponsored by AbbVie Medical Affairs + Health Impact. https://t.co/VHwUlGCV6R https://t.co/UB9SinoxCP

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Dr. John Cush @RheumNow( View Tweet )
NEW EULAR POSTER: Real-world impact of second-line treatment choice in patients with PsA! 🔎View the effectiveness of different PsA treatment patterns: TNFi to JAKi, TNFi to IL-17i, or TNFi to TNFi. Sponsored by AbbVie Medical Affairs + Health Impact. https://t.co/DZNZPrWWOD https://t.co/DRpczMWsqk

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Dr. John Cush @RheumNow( View Tweet )
New IDSA recommendation: In hospitalized on systemic steroids w/ severe, critical, progressing COVID-19, when baricitinib or tocilizumab are not available, IDSA guideline panel suggests infliximab. https://t.co/ZCkkZXUDpi https://t.co/gbgkvj5R8Y

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Dr. John Cush @RheumNow( View Tweet )
Claims data study of 82 399 PsA pts - 542 on combo targeted Rx >3 mos (200 > 6mos). 2 most common combos of apremilast w/ TNFi or IL-17i. Use of combo targeted Tx was not assoc. w/ more serious infxn (RRs 0.53; 0.17-1.63) or opportunistic infx (RR 1.00; 0.09-11.02) @ 3 or 6 mos https://t.co/mkvq1lqt9Y
Dr. John Cush @RheumNow( View Tweet )
TNF Inhibitors in Takayasu's Arteritis A large, retrospective, multicenter study demonstrated the efficacy of intravenous infliximab and subcutaneous adalimumab in patients with Takayasu arteritis. https://t.co/lJbvaYnylO https://t.co/uRBruhW2Fd

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Dr. John Cush @RheumNow( View Tweet )
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Uncertainty with immunosuppressive for idiopathic inflammatory myopathies

Jack Cush, MD

A current Cochrane review suggests a continued unmet need regarding the status and utility of targeted immunosuppressant and immunomodulatory treatments for the idiopathic inflammatory myopathies (IIM). Overall there has been little progress since the previous Cochrane review (2012) that found

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TNF Inhibitors in Takayasu's Arteritis

Jack Cush, MD

A large, retrospective, multicenter study demonstrated the efficacy of intravenous infliximab and  subcutaneous adalimumab in patients with Takayasu arteritis.

This multicentre study enrolled patients from Takayasu's referral centers in France, Italy, Spain, Armenia,

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There's a transient (1 yr) increase in New Abx Rx among 399 PsA pts after starting a TNF inhibitor. Pre-TNFi, PsA pts were more likely to recv Abx vs controls (1.26 vs. 0.60/yr; p<0.001). Post TNFi Abx use incr to 1.64/yr (p<0.001) but returned to baseline thereafter. https://t.co/LHXn5d7oC9
Dr. John Cush @RheumNow( View Tweet )
Difficult to manage SpA (D2M-axSpA) defined as failure ≥ 2 b/tsDMARDs (diff MOAs). Study of 129 axSpA pts, 8.5% were D2M, & 3% were treatment refractory (more inflammation- TR). D2M had signif higher BASFI (4.2 vs. 2.9), BASDAI (5.1 vs. 3.5), ASDAS (3.7 vs. 2.8). Predictors: https://t.co/4qdHEFxr3J
Dr. John Cush @RheumNow( View Tweet )
945 consecutive severe psoriasis pts Rx TNFi or nbUVB phototherapy (2005-2010) w/ median F/U > 9 yrs. After propensity matching, incidence of future PsA was 1.18/100 w/ TNFi vs 2.48/100 w/ nbUVB (IRR 2.1; 1.37–2.98, P = 0.0002). TNFi lowered PsA risk (HR = 0.32). PsA predictors https://t.co/aBsXs6RpCY
Dr. John Cush @RheumNow( View Tweet )
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Rheums Speak: Changing Rheumatology Practices & Choices

Jack Cush, MD

RheumNow surveyed clinicians worldwide on how their rheumatology practice, treatment decisions, and career outlooks have changed over the past 20 years. 242 respondents (68% from the USA) shared their perspectives on the changing landscape of rheumatoid arthritis care, practice patterns, and

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Full read review of DMARD effects on CV Risks. Strongest CV protective effects for MTX & TNF inhibitors. Potentially beneficial are sulfasalazine, hydroxychloroquine, & leflunomide. More info needed on IL-6, IL-17/23 inhibitors. Concerns over NSAIDs & JAKi https://t.co/0BW4StS15N
Dr. John Cush @RheumNow( View Tweet )
Large metanalysis of TNFi use in immune-mediated inflammatory diseases (45 studies, 150K pts) shows no increased risk of de novo heart failure (HF), and no significant risk of HF worsening w/ TNFis. https://t.co/9sRVsMZ1kv https://t.co/igCdcQMVK3

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Dr. John Cush @RheumNow( View Tweet )
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Repurposing & Pipeline (8.8.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, reports, pipeline and drug repurposing on this week’s podcast.

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COVID Vaccine study in rheum pts on JAKi (n 22) or TNFi (n 16) Showing 50% response in JAKi and 81% w/ TNFi Rx. Pt PBMCs were stim by SAR-CoV2 spike proteins & CD4+ T cells IFNγ production as Pos. response. Do JAKi impair COVID-19 Vax responses? https://t.co/dZAktwrytf https://t.co/mjkBfcGcfD

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Dr. John Cush @RheumNow( View Tweet )
Retrospective review of 9 #RA pts w/ elevated liver enzymes who were Rx w/ TNF inhibitor (4 adalimumab, 5 etanercept; 78% female, median BMI 37). Over 3 yrs F/U, LFTs declined, fibrosis scores (FIB-4) signif decreased; albumin & bilirubin remained stable https://t.co/Hcwa3qaupv https://t.co/OwGY5jxxyZ

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Dr. John Cush @RheumNow( View Tweet )
Full read review of DMARD effects on CV Risks. Strongest CV protective effects for MTX & TNF inhibitors. Potentially beneficial are sulfasalazine, hydroxychloroquine, & leflunomide. More info needed on IL-6, IL-17/23 inhibitors. Concerns over NSAIDs & JAKi https://t.co/INEdCt0pxa
Dr. John Cush @RheumNow( View Tweet )
Large metanalysis of TNFi use in immune-mediated inflammatory diseases (45 studies, 150K pts) shows no increased risk of de novo heart failure (HF), and no significant risk of HF worsening w/ TNFis. https://t.co/9sRVsMZ1kv https://t.co/Kapg9ZwVGf

Links:

Dr. John Cush @RheumNow( View Tweet )
MTX or TNFi use in elderly #RA pts w/in a year of Dx of melanoma was not associated with increased mortality. This included melanoma in situ (48%), localized (47%) and regional (5%) melanoma. Steroid use however was assoc w/ reduced survival. https://t.co/QOXfEf51S1 https://t.co/GZ5dedEMfM

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Dr. John Cush @RheumNow( View Tweet )
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A New RA Approval (8.1.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and a new treatment for RA from the FDA.

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Pregnant Women on TNFi more likely to use throughout gestation, w/ less steroids. 3711 preg on TNFi in 49,925 F (w/ RA, AS, PsA, PsO, IBD) -- 64% had 3 trimester TNFi use. 89% exposed preconception & 68% cont postpartum. TNFi use incr from 55% to 73% i(20111-21) https://t.co/DVvbwx6MoW
Dr. John Cush @RheumNow( View Tweet )
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FDA Approves Vagal Nerve Stimulator for RA

Jack Cush, MD

SetPoint Medical announced that the FDA has approved the company’s SetPoint System, a first-in-class neuroimmune modulation innovation for treatment of moderate-to-severe rheumatoid arthritis (RA) for those who are not adequately managed by—or cannot tolerate—existing advanced RA therapies, such

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Factors Affecting Biologic Use in Rheumatoid Arthritis

Jack Cush, MD

A San Francisco Rheumatoid Arthritis Panel cohort survey between 1999–2011, showed numerous sociodemographic, disease, and health characteristics that influenced the initiation of treatment with biologic agents for rheumatoid arthritis (RA).

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MTX or TNFi use in elderly #RA pts w/in a year of Dx of melanoma was not associated with increased mortality. This included melanoma in situ (48%), localized (47%) and regional (5%) melanoma. Steroid use however was assoc w/ reduced survival. https://t.co/QOXfEf51S1 https://t.co/6BPtEV6sOU

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Dr. John Cush @RheumNow( View Tweet )
TNFi are relatively contraindicated in RA pts w/ #MS. Literature review suggests for pts w/ MS and RA, teriflunomide and anti-CD20 therapies are the most suitable, and Cladribine may also be considered https://t.co/gIVaJ7Kwn0 https://t.co/1ar0q2OnzB

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Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Infections Rheums Should Worry About

Cassandra Calabrese, DO
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With the increasing development and use of new biologics and oral targeted therapies to treat RA and other immune mediated inflammatory diseases, an awareness of infection risk and prevention has become of increasing interest as well. While our patients may be susceptible to many different types of infections depending on immunosuppressive regimen, age and co-morbidities, I’ll highlight a few of the “usual suspects”. Read Post

Hard Conversations: DMARDs and Malignancy

Michael Putman, MD, MSCI
Risk Option Decision
Cancer is the most difficult DMARD risk to discuss with patients. Few warnings could scare people away from a drug faster than the words “may increase risk of cancer,” yet the risks (even when substantiated) have all been low and may be counterbalanced by the benefits of disease control. Read Post
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