E111: PEXIVAS Subsets with Mike Walsh & Mats Junek

New RCT in a new disease with a new drug! But is it as shiny as one would hope? Interesting discussion today about what a trial means, how it will affect practice, and how we could do better as a field. Happy holidays everyone! 

Reading one of my recent newsletters this week, this one about PMR tapers. Be sure to subscribe at ebrheum.com if you want access to the visuals and upcoming editions!   

Quick rundown of an important rheumatology RCT this week, discussing the IL-5 inhibitor benralizumab for the treatment of relapsing/refractory EGPA.    MANDARA Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2311155

Important methodology podcast this week, covering a lot of ground with expert epidemiologist Rishi Desai. Really enjoyed our conversation and glad to be publishing today!  **House Keeping Note: we actually recorded this ~15 months ago but I somehow lost the audio... which somehow re-appeared! #technology  STAR-RA: https://pubmed.ncbi.nlm.nih.gov/35027405/  

Exciting podcast this week about the upcoming / impending use of CAR-T in rheumatology. Highly recommend rheumatologists learn about this now; it's going to be a big thing for many years to come. In a future episode I will lay out my case for skepticism, but for now I think a good run down of the first big published series will be enough!    NEJM CAR-T Case Series: https://www.nejm.org/doi/full/10.1056/NEJMoa2308917 Nature Review Article: https://www.nature.com/articles/s41584-024-01139-z  

This week's podcast will be a quick read of one of my newsletters. The title basically speaks for itself! Find the newsletter and my other work at ebrheum.com 

At ACR23 I had a twitter-disagreement about steroid tapers from PEXIVAS with Mike Walsh, the lead author on the PEXIVAS trial. He kindly agreed to join me for a moderated discussion. Loved hearing his perspective and have to admit he pulled me closer to his practice... but not all the way there. Longer podcast than usual but I prefer to release audio uncut and this took as long as it needed! Hoping y'all enjoy.    Articles referenced during the podcast:  PEXIVAS: https://www.nejm.org/doi/full/10.1056/nejmoa1803537 PEXIVAS DAH Subset: https://www.atsjournals.org/doi/10.1164/rccm.202308-1426OC Fussner Abstract: https://acrabstracts.org/abstract/characteristics-and-outcomes-of-participants-with-and-without-diffuse-alveolar-hemorrhage-in-the-plasma-exchange-and-glucocorticoids-in-severe-anca-associated-vasculitis-pexivas-trial/ Walsh Meta Analysis: https://pubmed.ncbi.nlm.nih.gov/35217545/  

Rheum4Debate is back! In this episode I moderated a debate between two pulmonologists about RA-ILD. As a reminder, Rheum4Debate is an Oxford-style debate show, where two debators disagree over a motion during 3 rounds of discussion. The motion for todays show was:  “Asymptomatic patients with rheumatoid arthritis and high risk features for interstitial lung disease should be screened using pulmonary function testing and a high resolution CT scan” Joshua defended the motion and Scott argued against it. I thoroughly enjoyed the discussion and am sure you will as well! 

Nice study this week on an important topic. Can we prevent the development of rheumatoid arthritis by initiating DMARDs during a preclinical phase? Lots to discuss: what does it mean to be "pre-clinical?" How does this fit with other studies of this nature?    Check it out! https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02650-8/fulltext

Informative podcast this week with Dr. Alexander Oldroyd, the first author of the recently published "International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening." The article itself appeared in Nature Reviews Rheumatology and provides what I think is a very useful framework for approaching this issue. Article: https://www.nature.com/articles/s41584-023-01045-w