E120: Real Life Use of PEXIVAS-Low

What do you do when observational data and RCTs conflict? This week I'm covering the "real world PEXIVAS" study that was done by the French Vasculitis Study Group. Great read, interesting issues, have a listen and be sure to share with friends! 

One of my rare case-report podcasts, a topic that I typically avoid. The craze about CAR-T has also made me a little crazy, though, so I wanted to share what I think may be the ultimate destination for "more B cell depletion than rituximab" strategies.    Article: https://www.nejm.org/doi/full/10.1056/NEJMc2407150

Podcast this week about overdiagnosis! Currently one of my favorite topics and something that I think will be an emerging issue in our field. We recently published a Viewpoint in Lancet Rheumatology (https://pubmed.ncbi.nlm.nih.gov/39341221/) addressing this issue. I'm going to read from it and after that will be giving a few final (spicy) thoughts on the topic. Hope you find it worthwhile! s

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/