TNF inhibitor

Cochrane review of TNF inhib. in #JIA shows TNFi efficacy, but uncertainty about LT safety, pain, function, & Dz control - esp compared to MTX. 9 studies, 678 JIApts, age 8-15 yrs (80% F), Dz duration 0.8-6.7 yrs. Withdrawls 1% v 3%; Serious AE 6% v 7% (PBO vs TNFi).… https://t.co/i35m5uzG1m https://t.co/VzJN9PmmMh
Dr. John Cush @RheumNow( View Tweet )
TNF Inhibitor Drug-Induced Lupus A study from the FDA's adverse event reporting system (FAERS or Medwatch) database identified cases of drug induced systemic lupus erythematosus (SLE) in patients receiving tumor necrosis factor-α (TNF-α) inhibitors - a paradoxical reaction to… https://t.co/LYq0qxDtp3 https://t.co/vRYrBAIMEA
Dr. John Cush @RheumNow( View Tweet )
Cochrane review of TNF inhib. in #JIA shows TNFi efficacy, but uncertainty about LT safety, pain, function, & Dz control - esp compared to MTX. 9 studies, 678 JIApts, age 8-15 yrs (80% F), Dz duration 0.8-6.7 yrs. Withdrawls 1% v 3%; Serious AE 6% v 7% (PBO vs TNFi).… https://t.co/twmYfFg702 https://t.co/hG3j4sMPr9
Dr. John Cush @RheumNow( View Tweet )
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TNF Inhibitor Drug-Induced Lupus

Jack Cush, MD

A study from the FDA's adverse event reporting system (FAERS or Medwatch) database identified cases of drug induced systemic lupus erythematosus (SLE) in patients receiving tumor necrosis factor-α (TNF-α) inhibitors - a paradoxical reaction to common antiinflammatory biologic agents.

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US nationwide claims data study of CV outcomes (MACE) in #RA based on b/tsDMARD (n=34375) exposures (71% TNFi, 10% JAKi, 8% ABA, 5% RTX, 5% IL-6i). Compared to TNFi, RTX (HR 1.5) & IL-6i (HR 1.3) had numerically higher, but not statistically significant, MACE risk.… https://t.co/GXunfMY3US https://t.co/XYZPt0kzGE
Dr. John Cush @RheumNow( View Tweet )
Targeting PD-1 in Rheumatoid Arthritis The results of the large Phase 2b RENOIR trial showed that rosnilimab, a monoclonal antibody targeting PD-1, was effective in moderate-to-severe rheumatoid arthritis (RA) patients. https://t.co/ZsS3JOqdLh https://t.co/3JByNrLTGR

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Dr. John Cush @RheumNow( View Tweet )
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CRP and Hidradenitis Supprativa

Jack Cush, MD

A post hoc analysis of 2 phase 3 randomized clinical trials (PIONEER I and II)  of adalimumab vs Placebo in patients with active Hidradenitis suppurativa (HS) demonstrated more severe HS that was associated with elevated CRP had a higher BMI. Adalimumab was equally effective in patients

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Full read, comprehensive review of Hidradenitis Supprativa in Lancet Feb 1, 2025 Common assn; DM, IBD, Smoking, Obesity, metabolic syndr, NASH, SpA, RA FDA approved Rx: Adalimumab, Secukinumab, Bimekizumab https://t.co/5Tb8on21E0 https://t.co/BLu6Zaejj5

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Dr. John Cush @RheumNow( View Tweet )
New for HS - Bimekizumab is 3rd FDA approved therapy based on BE HEARD 1&2 - Other approved ADA (2015, PIONEER 1&2), SEC (2023, SUNRISE/SUNSHINE) Clinical trials: IL23 failed, ILalpha failed Brodulamab (IL17a) clinically meaningful response TNF trials @RheumNow #ACR2025 https://t.co/BfzwNQ1wUB

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Eric Dein @ericdeinmd( View Tweet )
-HS ttx👇 1. Lifestyle changes: smoking cessation, obesity. 2. Management of comorbidities. 3. 🔍HS- related autoimmune disorders. 4. FDA approved biologics: -Adalimumab (PIONEER 1&2) -Secukinumab (SUNRISE, SUNSHINE) -Bimekizumab (BE HEARD 1&2) "Theres no such… https://t.co/G5Voxrm3Kt https://t.co/dLGtoFZMd1

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Adela Castro @AdelaCastro222( View Tweet )
TNF inhibitor use did not affect mortality outcomes in 3 cohorts w/ early Cancer (colorectal [514], lung [864], & prostate [603]). 12-20% of CA pts recv TNFi. Overall survival at Yr 1 unaffected in colorectal (HR 0·72; 0·43–1·21), Lung (0·70; 0·49–1·00), Prostate (0·80;… https://t.co/Pi8rNuvioO

Dr. John Cush @RheumNow( View Tweet )

Adalimumab Withdrawal in Uveitis Patients Adalimumab is an effective treatment for JIA-associated uveitis and has been FDA approved for such use - but for how long and can the drug be withdrawn? An adalimumab (ADA) withdrawal trial has shown recurrence of uveitis, arthritis, or… https://t.co/J1CRgC3GJz https://t.co/8eOSvl5zZm
Dr. John Cush @RheumNow( View Tweet )
Hepatitis B (Keep)

AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals

Jack Cush, MD

The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.

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North American Real-world EHR data of PsA & axSpA pts (n 2200 Ea.) found no higher rates of CVD (acute MI, CVA or revascularization) or solid cancers (breast, colorectal, lung, prostate) when comparing JAKi to either TNFi or IL-17i use (over 3 years). https://t.co/macjpWxdnY https://t.co/9gXiomU3YD

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Dr. John Cush @RheumNow( View Tweet )
uveitis eye iritis

Adalimumab Withdrawal in Uveitis Patients

Jack Cush, MD

Adalimumab is an effective treatment for JIA-associated uveitis and has been FDA approved for such use - but for how long and can the drug be withdrawn? An adalimumab (ADA) withdrawal trial has shown recurrence of uveitis, arthritis, or both, when the disease was previously controlled on ADA.

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Getting to Remission - Without Biologics Analysis of data from two early rheumatoid arthritis (ERA) cohorts shows remission in RA is primarily seen in those who do not require biologic DMARDs (bDMARDs), while those needing bDMARDs are less apt to achieve remission.… https://t.co/K1gUdEhk1n https://t.co/PHQafKPHpB
Dr. John Cush @RheumNow( View Tweet )
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Weak Data (1.24.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com, and features Dr. Charity Dean, the Keynote speaker at RheumNow Live 2025, and why she is an inspiration.

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DMARDs,biologics,RA

Getting to Remission - Without Biologics

Jack Cush, MD

Analysis of data from two early rheumatoid arthritis (ERA) cohorts shows remission in RA is primarily seen in those who do not require biologic DMARDs (bDMARDs), while those needing bDMARDs are less apt to achieve remission.

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Korean population-based study shows that from 2010 to 2023 prevalence of ank Spondylitis (AS) increased 27 per 100,000 (2010) to 82 per 100,000 (2023). Also increasing were # of pts >50 yrs (20-33%), #females (18-24%), Comorbidities, TNFi use (30-43%), while csDMARDs declined.… https://t.co/9NjU1IugaF https://t.co/kTCtIj2BjD
Dr. John Cush @RheumNow( View Tweet )
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Fallen Angels (1.17.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com; and pays homage to colleagues who passed away in 2024.

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SetPoint Medical has applied to FDA for pre-market approval of Vagal nerve neuroimmune modulation device to Rx mod-severe #RA, not responding to 2 biologics. Based on RESET-RA 242 pt, 12 wk RCT showing ACR20=35% vs 24% PBO resp. SAE only 1.7%. https://t.co/d8RfXBFUSS https://t.co/Fq1qkfo1NM

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Dr. John Cush @RheumNow( View Tweet )
Post hoc study of Hidradenitis suppurativa (HS) phase 3 study w/ 588 pts rx w/ either PBO or adalimumab. 79% had elevated CRP. High CRP assoc w/ more severe HS, higher BMI (34 vs 28; P < .001), & lower odds of ADA response (OR 0.53). Activity or Obesity? https://t.co/ZQzumtW2LV https://t.co/FWaQMyP2TT

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Dr. John Cush @RheumNow( View Tweet )
UKs University of Birmingham researchers have just been awarded £3.5 million funding from Johnson & Johnson to investigate mechanisms of response and non-response to biologic and targeted synthetic therapies in rheumatoid arthritis. https://t.co/or9amYqljz https://t.co/EvDhVfqOig

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Dr. John Cush @RheumNow( View Tweet )
Antiviral prophylaxis is essential for HBsAg+ patients receiving cytokine inhibitors, given the high risk of reactivation. Metanalysis of 10 studies shows reactivation in 21% of HBsAg+ patients without prophylaxis vs 4.4% in HBsAg−/HBcAb+ patients. https://t.co/eHzIeA8uJK https://t.co/CmZw8C8ibn

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Dr. John Cush @RheumNow( View Tweet )
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ICYMI: VITAL Info on Autoimmune Disease (2.9.2024)

Jack Cush, MD

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)".

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Recent Blogs

Infections Rheums Should Worry About

Cassandra Calabrese, DO
TB.EMimage.CDC_.jpg
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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