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Biologics/DMARDs

When to Check Drug Levels & Why

Stephen J. Balevic, MD, PhD, RhMSUS  |  March 7, 2024

Checking blood levels of commonly used disease-modifying anti-rheumatic drugs (DMARDs) has gained widespread attention in the rheumatology community, even resulting in a recent guidance document from EULAR for biologics.1 Although a highly useful tool, drug level measurement in rheumatology is not without challenges; many of our drugs violate the basic principles of pharmacology that we…

FDA Issues Boxed Warning for Denosumab & Approves a Generic NSAID

Michele B. Kaufman, PharmD, BCGP  |  February 27, 2024

In January, the U.S. Food & Drug Administration approved indomethacin in an oral suspension, a generic version of Indocin Oral Suspension. The agency also issued a boxed warning and updated label for denosumab, warning of the risks of severe hypocalcemia in patients with chronic kidney disease.

3 AC&R Study Summaries: Prescribing Patterns, PMR & Glucocorticoids, & Infection Screening

Arthritis Care & Research  |  February 9, 2024

A Shift in Prescribing Patterns Safety issues prompt discontinuation of tofacitinib By Stephanie Song, MD, & Joshua F. Baker, MD, MSCE Why was this study done? The ORAL Surveillance study highlighted risks of cardiac events, thromboembolism (VTE) and malignancy associated with use of Janus kinase inhibitors (JAKi). We sought to determine the impact of safety…

Study Assesses Sarilumab for Polymyalgia Rheumatica

Ruth Jessen Hickman, MD  |  January 25, 2024

In an ACR Convergence 2022 session, Robert Spiera, MD, director of the Scleroderma, Vasculitis, and Myositis Center at the Hospital for Special Surgery, New York City, discussed the use of sarilumab as a potential glucocorticoid-sparing therapy in a phase 3 study in patients with treatment-refractory polymyalgia rheumatica (PMR), one of the most common inflammatory diseases…

FDA Approves Sarilumab for Adults with Glucocorticoid-Resistant Polymyalgia Rheumatica

Michele B. Kaufman, PharmD, BCGP  |  January 25, 2024

On Feb. 28, 2023, the U.S. Food & Drug Administration (FDA) approved sarilumab (Kevzara) for the treatment of adults with polymyalgia rheumatica (PMR) for whom glucocorticoids have proved inadequate or who cannot tolerate a glucocorticoid taper.1,2 Sarilumab is an interleukin (IL) 6 receptor antagonist. In May 2017, the FDA initially approved the agent for the…

How to Treat Refractory Polymyalgia Rheumatica

Katie Robinson  |  January 25, 2024

Patients with polymyalgia rheumatica (PMR) who had relapsed while tapering glucocorticoid therapy were more likely to achieve sustained remission at one year and have a lower glucocorticoid exposure if they were treated with sarilumab (Kevzara) plus a rapid, 14-week glucocorticoid taper than if they received placebo plus a standard, 52-week glucocorticoid taper. This is according…

Study: Most Patients with PMR Aren’t Getting Steroid-Sparing Agents in First 2 Years

Katie Robinson  |  January 25, 2024

A minority of patients with polymyalgia rheumatica (PMR) who were new to rheumatology practice were prescribed steroid-sparing agents through two years of follow-up. This is according to a large, U.S.-based cohort study, published in Arthritis Care & Research, which also found that nearly two-thirds of the patients remained on glucocorticoids beyond one year.1 “Our study…

When a JAK Inhibitor Fails

Michele B. Kaufman, PharmD, BCGP  |  January 24, 2024

What Are the Therapeutic Alternatives When a Janus Kinase Inhibitor Fails to Work? SAN DIEGO—Treatment alternatives after Janus kinase (JAK) inhibitor failure in real-life conditions were analyzed and presented at ACR Convergence 2023 by Pablo Francisco Muñoz Martínez, a rheumatologist at the Hospital Universitario y Politécnico La Fe, Sagunto, Spain.1 JAK inhibitors are newer, targeted…

Study Probes Corticosteroid Dependence in Polymyalgia Rheumatica

Vivekanand Tiwari, MD, Emily Campbell, MD, Joshua Skydel, MD, Bryan Savage, MD, Monica Dimambro, Todd MacKenzie, PhD, & William F. Rigby, MD  |  January 24, 2024

Background/Purpose Polymyalgia rheumatica (PMR) treatment is primarily based on long-term corticosteroids, which results in significant toxicities. Studies have shown that patients with PMR are exposed to years of corticosteroid treatment.1,2 In a single academic center cohort, we found that 76% of patients remained on steroids at the end of two years.3 In a second cohort…

How Prevalent Is Subclinical Giant Cell Arteritis in Polymyalgia Rheumatica?

Colm Kirby, MB, BCh, BAO, MRCPI, Rachael Flood, MB, BCh, BAO, MRCPI, Ronan Mullan, MB, BCh, BAO, MRCPI, Grainne Murphy, MB, BCh, BAO, MRCPI, & David Kane, MB, BCh, BAO, MRCPI  |  January 24, 2024

Background/Purpose It has been reported that 20–50% of patients with polymyalgia rheumatica (PMR) have subclinical giant cell arteritis (GCA). The natural history of ultrasound-defined subclinical GCA in PMR is not known. Methods Twenty-five newly diagnosed PMR patients who met a clinical diagnosis for PMR, verified by two rheumatologists, were examined by ultrasound. All six branches…

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