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Drug Safety

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What Worries You, Masters You (7.1.2022)

Jul 01, 2022

Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com.  Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.




  1. FDA approved Abbvies risakizumab-rzaa

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Novel Anti-TNF Shines in Rheumatoid Arthritis Trial

MedPage Today
Jun 30, 2022

A new way of inhibiting tumor necrosis factor (TNF) for treating rheumatoid arthritis showed strong results in a phase II/III clinical trial, researchers said.



About 75% to 80% of patients receiving an investigational agent called ozoralizumab achieved 20% reductions in symptoms by

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Placebo Works Best in Combination

Jun 30, 2022

Analysis of two large clinical trial datasets shows that placebo response rates in randomised controlled trials (RCTs) of patients with rheumatoid arthritis are better when the patient continued background methotrexate (MTX). 



RA patients with an insufficient MTX can either continue

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GRAPPA,PsA,guideline

New Updated GRAPPA Psoriatic Arthritis Recommendations

Jun 29, 2022

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis,

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Gabapentin Implicated in Overdose Deaths

Jun 29, 2022

Recent FDA and MMWR warnings suggest that gabapentin was present and implicated in almost 10% of US overdose deaths between 2019 and 2020. This CDC report also stated that gabapentin was the cause of the death in half of these cases. 



Despite its FDA approval for the management of

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heart,cv,meds, events, CVD

HCQ for RA: Not a Great Idea?

MedPage Today
Jun 28, 2022

Hydroxychloroquine (HCQ) appeared less safe from a cardiovascular standpoint than methotrexate in older patients with rheumatoid arthritis (RA), analysis of Medicare data indicated.



Among RA patients 65 and older with a history of heart failure, major cardiovascular events occurred

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Are You Wasting Money on Supplements or Vitamins?

Jun 27, 2022

The US Preventive Services Task Force (USPSTF) has updated its recommendations regarding the efficacy of supplements or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population.



The USPSTF concluded there is insufficient

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Inferior IL-17 Inhibitor Responses in Psoriatic Women

Jun 27, 2022

Pooled data from two large ixekizumab (IXE) trials show that male patients had greater clinical responses than did female patients with psoriatic arthritis are largely unexplored. Reasons for this differential treatment responses to an interleukin-17A inhibitor (IXE) between male and female

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It's time to exonerate methotrexate in causing or exacerbating fibrotic interstitial lung disease in #RA patients https://t.co/AuEIWn8Pc4 https://t.co/razVTF6fFX
Dr. John Cush @RheumNow( View Tweet )
Jun 27, 2022
Metanalysis of 7 studies shows that oral anticoagulants need not be discontinued for joint injections or aspiration. Only pts w/ hemorrhage after 5427 procedures, over 32-yrs. INR values of 3 bleeding cases was 1.9, 2.3, and 3.4. https://t.co/pCxDqzXGHQ https://t.co/ExZkXSliFo
Dr. John Cush @RheumNow( View Tweet )
Jun 26, 2022
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Bimekizumab Safety in Psoriasis Patients

Jun 23, 2022

A pooled analyses of data from eight, phase 2 and 3 randomized clinical trials shows bimekizumab, a dual IL-17A/F inhibitor, to be effective in plaque psoriasis and was well tolerated aside from an increased incidence of mild to moderate oral candidiasis. 



The cohort included 1789

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Simultaneous Versus Staged Knee Arthoplasty?

Jun 23, 2022

Aside from cost, there are significant concerns regarding efficacy and safety outcomes and recovery time. These issues are compounded with the need for bilateral TKR, wherein the patient and surgeon need to decide whether to have both TKRs done simultaneously or staged (single TKR one after

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Jakne (acne) with upadacitinib: review of 857 Psoriasis pts on UPA by wk 16 9.8-15.2% c/o mild/moderate acne; only 2 D/C for acne. Higher rates seen among younger, female, non-White patients. (This rare in RA!) https://t.co/cN6NU7e5sb https://t.co/JAMYS8EIwN
Dr. John Cush @RheumNow( View Tweet )
Jun 20, 2022
Long term risk of Herpes zoster in 1157 pts on tofacitinib for ulcerative colitis was Tofa 3.62 vs PBO 1.98/100PY during induction; during maintenace was Tofa 5mg 2.05 vs 10 mg 6.64 vs PBO 0.97/100PY. Higher risk w/ age, low wt, prior TNFi, N.American https://t.co/E3PGvejAUF https://t.co/k8PIT2o5KI
Dr. John Cush @RheumNow( View Tweet )
Jun 20, 2022
JAKi not yet safe in pregnancy - theyre fetotoxic at high doses (animals). JAKi do cross placenta. ACR Guidelines: no position due to no data. 47 tofa Rheum & 15 UC maternal exposures - no signif probs. Paternal use of JAKi is ok.https://t.co/PoIheshd2n https://t.co/gjTN2Uz4IP https://t.co/OAfLRvSFBs
Dr. John Cush @RheumNow( View Tweet )
Jun 19, 2022
#EULAR2022 has concluded but you can find all our coverage here https://t.co/s62OVJPQ86 https://t.co/QAvPQYCABj
Dr. John Cush @RheumNow( View Tweet )
Jun 18, 2022
Flares Not Increased Following RZV Injections Insurance claims analysis has shown that the use of the RZV for prevention of HZ was highly used in patients with IMIDs and was safe, as higher rates of arthritis flares were not evident.https://t.co/E27oIBlEDb https://t.co/VbtDnmRYzO
Dr. John Cush @RheumNow( View Tweet )
Jun 17, 2022
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Two Week Twitter (6.17.2022)

Jun 17, 2022

Dr. Jack Cush does a 2-week review of RheumNow Tweets on news and journal citations worth noting, along with some opinions on Telehealth, manpower, monkeypox and the price of drugs.




  1. Although Rheumatology currently ranks 2nd or 3rd in specialty use of telemedicine - the vast

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Vaccination,vaccine

Flares Not Increased Following Recombinant Zoster Vaccine Injections

Jun 15, 2022

Insurance claims analysis has shown that the use of the (CDC recommended) recombinant zoster vaccine (RZV) for prevention of herpes zoster was highly used in patients with immune-mediated inflammatory diseases and was safe, as higher rates of arthritis flares were not evident.

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450 axSpA pts followed 2868 Pt-yrs, 48% on TNFis. TNFi Rx pts had reduced CV risk (HR 0.30; 0.10–0.85), but no longer signif after adjustment for CRP, ESR (HR 0.37, 0.12–1.12, p = 0.077). Reduced CV risk, may not be specifically due to TNFi use https://t.co/mVHYn3PteL https://t.co/bgKWreBL8z
Dr. John Cush @RheumNow( View Tweet )
Jun 14, 2022
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Improved Pregnancy Outcomes in SLE (2010–2020)

Jun 14, 2022

A retrospective cohort study has shown that outcomes in pregnant systemic lupus erythematosus (SLE) patients has significantly improved in the last decade, but there still is a high risk of adverse pregnancy outcomes (APO).



A retrospective Danish SLE cohort was used to identify

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GLORIA Study Pred vs PBO in >65yrs RA x 2 years. 451 Pts & DAS28 4.5. 79% on DMARDs (14% biologics) Upside: Lower DAS28 -0.37 & less Xray progression -1.7 Sharp units Downside: 24% more AE (mild infxns), signif.small lowering of lumbar BMD -1% You Decidehttps://t.co/RRq0WcFsXz https://t.co/xLxjPPSMhh
Dr. John Cush @RheumNow( View Tweet )
Jun 13, 2022
CV risk factors not equal when considering magnitude of risk What can we learn from Oral Surveillance? The Oral Surveillance trial has almost become a household word for rheumatologists.https://t.co/LHZTVZh4AK https://t.co/2SlxrG7UpQ
Dr. John Cush @RheumNow( View Tweet )
Jun 13, 2022
Watch this 4 minute video on Belimumab use in pregnancy featuring Dr. Kathryn Dao ( @KDAO2011 ) https://t.co/8uRUIVURHF https://t.co/lbYwHFFJit
Dr. John Cush @RheumNow( View Tweet )
Jun 10, 2022
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EULAR 2022 Top 10 Abstracts (6.10.2022)

Jun 10, 2022

Dr. Jack Cush reviews the top abstracts from EULAR 2022  As chosen by me with the  aid of the RheumNow EULAR faculty. “Top” is relative and subjective, but my criteria for inclusion are based on impact, water cooler talk potential, innovation and social media buzz.  Speaking of social media

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