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RheumNow Podcast – The Bad News That’s Fit to Print (8.21.20)

Aug 20, 2020 10:26 pm

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

  1. Study of 2 Canadian centers finds amongst 2095 patients taking biologics for #Psoriasis, 23 (1.1%) stopped their biologic for "COVID-19 related concerns". 5/23 restarted biologic for PSO flares. This included TNFi, inhibitors of IL17, IL12/23, IL23
  2. Diabetes is a risk factor for COVID mortality; yet Metformin dramatically lowers mortality in a preprint, unreviewed paper - retrospective EHR review of 25,326 subjects COVID tested at UAB; metformin signif reduced mortality risk in DM w/ COVID (OR 0.33)
  3. Preprint analyses of RCTs and 11 nonRCTs showed JAK-inhibitor use in COVID-19 reduced mortality (OR 0.12; 0.03-0.39) & ICU admission (OR 0.05; 0.01-0.26). Similarly Type I interferon Rx also significantly reduced mortality (OR, 0.19; 0.04-0.85, p=0.03)
  4. NJ study of 764 ICU COVID-19 pts, 210 (27%) received tocilizumab. TCZ treated patients had a lower death rate (49% vs 61%) (HR 0·64, 95% CI 0·47–0·87; p=0·004). Similar results seen in those requiring mechanical vent. or CRP >15 mg/dL there delays in Dx-ing RA? 2019 UK NHS study shows median delays from 1st Sx to seeing a rheumatologist was 27 weeks, with 20% seen w/in 1st 3 mos. Includes a patient delay (5.4 wks), GP delay (6.9 wks) & hospital delay (4.7 wks)
  5. Study from 3 NYC lupus clinics compares flare rates in older SLE stopping HCQ (n 26) vs continuing HCQ (N 32) with no difference in lupus flare rates (19 vs 16%). Reasons for stopping HCQ: retinal toxicity 42%, pt preference 35%, adverse effects 15%
  6. Antibiotic use is associated with a higher rate of IBD (aOR 1.88; 1·79–1·98) based on a prospective case-control study from the Karolinska that compared 23,982 new IBD pts w/ 117,827 matched controls followed over 10 years.
  7. Forward study of 18,754 RA patients who experienced 1,801 CVD events and found CVD risk reduction with TNFi (HR 0.82 [95% CI 0.72-0.94]) and abatacept (HR 0.50 [95% CI 0.30-0.83]) compared to csDMARDs over & above MTX alone (use vs. non-use: HR 0.82)
  8. Single center prospective study of 50 severe SLE pts (age 31 - 28 yrs) Rx with either mycophenolate or IV CTX. Ovarian dysfunction was short lived and subclinical w/ CTX. No premature ovarian failure seen w/ CTX. No ovarian dysfunction w/ MMF.
  9. Filgotinib Decision Delayed by FDA
  10. Increased Lupus Anticoagulant Activity in COVID-19 Infection 
  11. Upadacitinib is Superior to Methotrexate in Early RA 
  12. BACK TALK - submit your questions or comments for discussion on the podcast!
The author has received compensation as an advisor or consultant on this subject

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