TNF inhibitor

Biologics Prevent AA amyloidosis progression to ESRD The study suggests that biologic drugs can prevent serious complications of rheumatologic and autoimmune diseases, with some products showing greater effectiveness than others. https://t.co/f04Jrzy9ae https://t.co/O6dgD5RvxZ

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Dr. John Cush @RheumNow( View Tweet )
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Biologics Prevent AA amyloidosis progression to ESRD

MedPage Today

One of the most serious complications of rheumat0logic and autoimmune diseases can be prevented with biologic drugs, a single-center chart review suggested, and some such products may be more effective than others.

Among 83 patients receiving biologic agents for their underlying

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From LG cohort of myeloid neoplasms (861 MDS, 640 AML, 112 MDS/MPN, 89 MPN) autoimmune Rheum Dz (AIRD) found in 7.7% (lit suggests 8-30%), less in AML (4.7% vs 9.5% others). Common: RA (42%), CTD(18%), PMR (14%), vasculitis (12%), AxSpA (7%). https://t.co/ZXxOrZBunZ https://t.co/m5nIgrhohw

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Dr. John Cush @RheumNow( View Tweet )
174 Active RA pts not responding to MTX were started on TCZ. High GM-CSF (> 5 ng/ml and > 10 ng/ml) at baseline were the independent predictors of poor response to TCZ at Wk24. high GM-CSF had signif higher DAS28-ESR & cytokine levels at baseline https://t.co/AreLBseJDq https://t.co/OyIOkiUOT1

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Dr. John Cush @RheumNow( View Tweet )
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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Dr. John Cush @RheumNow( View Tweet )
174 Active RA pts not responding to MTX were started on TCZ. High GM-CSF (> 5 ng/ml and > 10 ng/ml) at baseline were the independent predictors of poor response to TCZ at Wk24. high GM-CSF had signif higher DAS28-ESR & cytokine levels at baseline https://t.co/vy7czYwv1Z https://t.co/R2cYdNZ3V0

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Dr. John Cush @RheumNow( View Tweet )
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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Dr. John Cush @RheumNow( View Tweet )
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Pollution and Autoimmunity (7.12.2024)

Jack Cush, MD

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

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Efficacy of Biologics in Patients with Chronic KIdney Disease

Jack Cush, MD

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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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

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Dr. John Cush @RheumNow( View Tweet )
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Cost-Effectiveness of Biosimilars vs Leflunomide

Jack Cush, MD

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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ICYMI: 2023 EULAR Psoriatic Arthritis Recommendations

Jack Cush, MD

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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Abbvie announced upadacitinib (Rinvoq) is approved for use in polyarticular JIA and Psoriatic Arthritis (in children 2 years of age and older who have had an inadequate response or intolerance to 1 or more tumor necrosis factor (TNF) blockers) https://t.co/gvRzYpFl5i https://t.co/uSISWG3foy

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Dr. John Cush @RheumNow( View Tweet )
RT: @synovialjoints In a Swedish-Danish cohort study on patients with PsA, treatment with TNFi was associated with a small increased risk of NMSC and with non-significant numeric risk increases for both BCC and SCC compared with bDMARD naïve #EULAR2024 Abstract 0150

Dr. John Cush @RheumNow( View Tweet )

RT: @aurelierheumo TOLERA trial in RA RTX/ABA sequence versus RTX alone 10pts each group Primary outcome was ambitious: ACPA seroconversion No difference between ttmts (and also no seroconversion) No diff in disease activity No diff in ACPA change wt wk52 OP0069 #EULAR2024

Dr. John Cush @RheumNow( View Tweet )

TARGET compared triple DMARD to TNFi in 122 RA pts and association with CV risk. In a subanalysis they found no correlation between change in lipid measurements and change in vascular inflammation by FDG-PET. https://t.co/0HKogmdRGH https://t.co/cD7UVTgTQ3

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Dr. John Cush @RheumNow( View Tweet )
Swap or Cycle? Study OP0081 show after failure to a first TNFi in patients with axSpA, the drug retention rate was higher in the cycle strategy compared to the swap (IL-17i) strategy. No difference in the disease activity between cycle and swap strategy #EULAR2024

Dr. John Cush @RheumNow( View Tweet )

Potential of Radiomics to Predict TNF Therapy Outcomes in axSpA Dr. Bella Mehta interviews Dr. Vincenzo Venerito about abstract POS0236 at Eular 2024 in Vienna, Austria. https://t.co/mv9DeZ9cez https://t.co/1OpT3MomO8

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Dr. John Cush @RheumNow( View Tweet )
couple holding hands with baby shoes

RA: update for women of child bearing potential (and men!)

Aurelie Najm, MD, PhD

Fertility in the context of RMDs is a daily concern for a lot of rheumatologists and patients.

EULAR this year proposed new fertility data, especially in Rheumatoid Arthritis, along with an update of the EULAR points to consider for use of antirheumatic drugs in reproduction, pregnancy and

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RISK OF NON-MELANOMA SKIN CANCER WITH TNFi AND OTHER bDMARDs IN PATIENTS WITH PSORIATIC ARTHRITIS: A SWEDISH AND DANISH COHORT STUDY- despite having minimal sun 25% increase NMSC TNFis vs other bDMARDs - skin checks ! @RheumNow #EULAR2024

Peter Nash @drpnash( View Tweet )

EULAR Abstract Archive OP0031 (2024) COMPARATIVE ANALYSIS OF TNF INHIBITORS & IL17 INHIBITORS IN PSORIATIC ARTHRITIS: CARDIOVASCULAR OUTCOMES signif absolute risk diff 3 % ischaemic heart disease 2 % heart failure TNFi vs IL17i https://t.co/fNIiMt4caL. @RheumNow #EULAR2024

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Peter Nash @drpnash( View Tweet )

Points to consider in pregnancy in #rheumatic diseases 3 points ✅TNFi all OK 👍 ? Only if you can’t control disease use other #bDMARDs Baby #vaccinations if exposed to #biologics while present #rotovirus ok other live vaccines >6 mos #EULAR2024 @eular_org @RheumNow https://t.co/MyJdA7p7zh

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Janet Pope @Janetbirdope( View Tweet )
500+ pts AxSPA No difference in drug discontinuation between IL-17i, TNFi, IL23i over time Adjusted for CRP, co-medication w/ MTX + classic covariates IL-17i and IL-23i had experienced a higher number bDMARD failures #EULAR2024 POS0259 @RheumNow https://t.co/F3B6uXyAca

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Aurelie Najm @AurelieRheumo( View Tweet )
Cohort from Netherlands 400+ PsA pts IR first bioDMARD 300+ switched TNFi->IL-17i, 99 cycled TNFi->TNFi 3year retention rates 12 mo 75% cyclers 80% swappers 24mo 60% cyclers 56% swappers No difference in treatment failure or DAS28 CRP #EULAR2024 @RheumNow POS0278 https://t.co/J8ONjVAFqG

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Aurelie Najm @AurelieRheumo( View Tweet )
more evidence in PsA - switch MOA rather than cycle within class failed first TNF @RheumNow #EULAR2024 https://t.co/hf2UB5MXEy

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Peter Nash @drpnash( 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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