E134: Brepocitinib in Dermatomyositis (VALOR)

Great trial this week looking at brepocitinib in dermatomyositis. Looks like a winner, expect it will be approved. Where it fits in our approach to IIM is an open question, but nice to have another option.  Study: https://www.nejm.org/doi/10.1056/NEJMoa2503531 JC Companion: https://autoimmunedevreport.substack.com/  

Good RCT this week, investigating the CD20 B cell inhibitor obinutuzumab for SLE. Sign up for my newsletter if you would like to have a read-along companion piece!    Paper: https://www.nejm.org/doi/full/10.1056/NEJMoa2516150 Landing Page: https://ebrheum.com/ Substack: https://autoimmunedevreport.substack.com/

Quick podcast this week about a nifty head to head study that I had previously missed. Worth reading if - like me - you're still trying to figure out how the heck to manage osteoporosis.  Paper: https://pubmed.ncbi.nlm.nih.gov/28755782/

Today I cover the recent publication of the RESET-RA study, which evaluated vagal nerve stimulation to treat rheumatoid arthritis. Have a listen in full, but let me be clear upfront: I do not think this works and will not be referring any patients to receive it. This will forever be my pivotal example of the effect of unblinding, but would love to hear if you think different!    Paper: https://www.nature.com/articles/s41591-025-04114-7 Supplement (see S4): https://www.nature.com/articles/s41591-025-04114-7#Sec27    

Surprisingly (unbelievably?) impressive RCT evaluating the Blys/APRIL inhibitor "telitacicept" for patients with SLE (mixed SLE and SLE-LN). Very curious to see where the FDA goes with this one.    Paper: https://www.nejm.org/doi/full/10.1056/NEJMoa2414719

Ever wonder how often you really need to check "monitoring" labs? If so then this is the podcast for you! Bryant England mentioned this during his excellent Year in Review session at ACR Convergence 2025. I've been meaning to cover it and finally got around to doing so. Have a listen and share with friends!   Paper: https://pubmed.ncbi.nlm.nih.gov/40854212/

Covering a very interesting study this week, which investiaged the PDE4B inhibitor nerandomilast for patients with progressive pulmonary fibrosis (specifically including 325 patients with autoimmune ILD). Would have been yet another ho hum trial if not for the big reveal... have a listen to find out! Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2503643  

Another episode looking into safety this week! Tackling that pesky issue of TNFs and CHF. Be sure to subscribe to my newsletter and check out the papers below!    Newsletter: https://sprw.io/stt-ee87b4 ATTACH: https://pubmed.ncbi.nlm.nih.gov/12796126/ RENEWAL: https://www.ahajournals.org/doi/10.1161/01.cir.0000124490.27666.b2 Observational Studies: https://pubmed.ncbi.nlm.nih.gov/23155221/  

Covering an interesting but ultimately disappointing post hoc study of multiple upadacitinib trials in RA. Initially some hope for clarity in the "Do JAKs cause all the badness?" questions, but ultimately landing me about where I have been since ORAL-SURVEILLANCE was published Paper: https://www.sciencedirect.com/science/article/pii/S0003496724423091  

Interesting read this week - I cover a nifty little paper that presented data about adrenal insufficiency after stopping prednisolone, published in JAMA Open in March 2025.     Open Access Journal Here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831668