The Evidence Based Rheumatology Podcast

Quick episode today. I wanted to share an editorial that was recently published in Rheumatology, where I and co-authors (Shannon Tai and Natalie Anumolu) discuss lessons from recent trials in AAV and SLE. Link to editorial: https://pubmed.ncbi.nlm.nih.gov/35438142/

After some delay, I finally get around to discussing ORAL-Surveillance, a post-marketing safety study of tofacitinib for rheumatoid arthritis. It's an incredibly important trial that will likely affect how all of us practice for the foreseeable future. Link to paper: https://www.nejm.org/doi/full/10.1056/NEJMoa2109927

After a winter hiatus, the podcast is back! Today I wanted to dive into a 'hotbutton' issue - the question of whether (or not) COVID-19 vaccines "work" for patients with rheumatic diseases. My answer is an emphatic "yes," albeit with a few caveats. Here are the papers I discuss: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00034-0/fulltext https://pubmed.ncbi.nlm.nih.gov/35441151/

Hello again! Snappy episode this week about the exciting LoVAS trial, which compared a reduced dose steroid taper for ANCA vasculitis. Be sure to drop by my website at ebrheum.com to subscribe to my newsletter!

In this episode, I talk with Dr. Andy Abril, Chair at the Division of Rheumatology at the Mayo Clinic in Jacksonville Florida. Dr. Abril is one of the lead authors for the 2021 ACR Guidelines on Takayasu’s arteritis. This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening!

In this episode, I talk with Dr. Jason Springer, Co-Director of the Vanderbilt Vasculitis Center, about the guidelines for PAN He is one of the lead authors for the ACR/VF Guidelines for Polyarteritis Nodosa. This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening!

On today's episode I discuss GCA with Dr. Mehrdad Maz. He is the Division Director of the Kansas University Allergy, Clinical Immunology and Rheumatology Section and served on the Steering Core Committee of the ACR-VF Vasculitis Treatment Guidelines. We cover a lot of great topics! This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening!

In today's episode, I talk with Dr. Mehrdad Maz about the newly published guidelines for giant cell arteritis (GCA). Dr. Maz is the Division Director of the Kansas University Allergy, Clinical Immunology and Rheumatology Section. He serves on the Steering Core Committee of the ACR-VF Vasculitis Treatment Guidelines. This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening!

The guidelines have finally arrived! I'm kicking off the series today with a conversation about the ANCA vasculitis guidelines. My guest is Dr. Sharon Chung, the director of the UCSF Vasculitis Clinic and the lead investigator on the ACR/Guideline committee. She provided a LOT of great insights; have a listen and let us know what you think! This project was done in partnership with the Vasculitis Foundation. To review the complete guidelines, visit https://dev.vasculitisfoundation.org/2021-acr-vf-vasculitis-guidelines/ or vasculitisfoundation.org. You can find them on Twitter @vasculitisfound and I am @ebrheum. Thanks for listening!

Hopping in this week to round out my thoughts on ADVOCATE (avacopan in AAV) and covering the recently published AURORA trial for SLE nephritis. Back to the Vasculitis Guidelines Podcast after as soon as they are released!

In this episode we'll be introducing the process by which the 2021 ACR/VF guidelines were produced. My guest is Dr. Sharon Chung. She's the director of the UCSF Vasculitis Clinic and the lead investigator on the guideline committee. Please follow along with future episodes - you can find me @ebrheum and the Vasculitis Foundation is at @vasculitisfound and their website vasculitisfoundation.org.

Welcome to the first episode of the Vasculitis Guidelines Podcast! In Episode 1, I interview Joyce Kullman, Executive Director of the Vasculitis Foundation, about collaborating with the ACR in updating these guidelines, and how patients with vasculitis will ultimately benefit from them. We discuss the complex process of updating these critical guidelines involve years of input from researchers, physicians, and patient themselves.

Quick update on a new series!

Steroid free remission! Or is it? This week I discuss a really exciting trial in ANCA vasculitis.

I stole some time to tackle a pressing issue for rheumatologists - to hold or not to hold immunosuppression in patients who are receiving a COVID19 vaccination. We obviously don't have any data on this, but I have always loved this study on influenza vaccination. PDFs at ebrheum.com/twts and follow me on twitter @ebrheum!

We have a great show for you this week! Anisha Dua will be moderating a debate between myself and Max Konig on this motion: "Hydroxychloroquine levels should be monitored in patients with SLE." I learned a ton and thoroughly enjoyed it. Be sure to vote on the post-debate twitter poll to decide the winner!

This week I cover another of my meta-research projects, this one on systematic review and meta analysis (SRMA) growth as compared to randomized clinical trial (RCT) growth. Short and to the point - hope you enjoy! I highly recommend checking out the associated graphs - just take a quick peek at some point while listening. Find them on my twitter handle @ebrheum

Active comparator trial! Always my favorite. Lots of fun topics in this one, including noninferiority trials, crafty endpoints, and PROs. Check it out and let me know what you think! @ebrheum

Another day, another lupus trial, another round of endpoint shenanigans. Why does that matter? How big is the benefit from belimumab in SLE nephritis? Will this save lives and prevent ESRD / RRT? I try to tackle these issues this week and (hopefully) avoid getting myself in trouble. Hope you enjoy the episode! Let me know what you think @ebrheum on twitter!

Great paper to discuss this week - one that may be too good to believe? I highly recommend checking out the pdf first (ebrheum.com/twts) - their graphics are wonderful and do a great job of conveying their message. Also, check out the "2-5-10" rule that I referenced! This is required reading for anyone who rotates with me - easily one of the most useful EBM papers I have ever read.

Quick podcast this week that expands on issues I discuss in Episode 55. Go back and listen to that one first if you have time! I think this is an important issue and it's one I'd like to highlight. Let me know what you think @ebrheum and please share with friends!

The podcast is back! I tune in briefly here to explain where I've been, what I'm doing, and where this will be headed. Feel free to skip right ahead if you'd rather just dig back in!

PEXIVAS has landed! This week I go over the trial and my take on it's results. Impressive undertaking that answered two questions for a subset of patients with AAV - well worth the time to kick back and read the trial in full. Let me know what you think about the podcast @ebrheum!

(Yet) another RCT this week! Nice investigator initiated trial with many wonderful strengths and a few crippling flaws. Great opportunity to think about a common problem in practice as well as a separate common problem in trials!

This week I talk about the recently published TULIP 1 and TULIP 2 trials that assessed anifrolumab for active SLE. Great to see a new drug in this disease state; interesting to think through how these trials played out. Get the papers and the pod at ebrheum.com and follow me @ebrheum if you'd like to share feedback!

Happy New Year! This week Dr. Anisha Dua (@anisha_dua) and Dr. Sarah Fantus (@sarahfantus) debate this motion: "In MTX non-responders with RA, triple therapy (adding HCQ & SSZ) should be first line." Please be sure to VOTE AGAIN on twitter (@ebrheum) after you have listened!

This week I go back to a topic from episode 42, the SENSCIS trial and nintedanib for SSc-ILD. The way this medication has been received and a recent article I wrote for The Rheumatologist gave me a nice jumping off point to cover a few more issues from this. Be sure to follow me @EBRheum to let me know what you think! The corresponding article is available here: https://www.the-rheumatologist.org/article/fda-approves-nintedanib-for-ssc-ild-but-temper-your-expectations/

Surprising RCT this week discussing the HOPE trial, which pitted 10mg prednisone against placebo for inflammatory hand OA. I do think this will change my practice, but in a far narrower sense than the headline would suggest. Check it out and find all my other content at ebrheum.com!

Rheum4Debate is back! This week we have Dr. Anisha Dua arguing in support of the motion, "Patients with newly diagnosed GCA should start glucocorticoids WITH tocilizumab over glucocorticoids alone." I argue against the motion and Dr. Sarah Fantus was kind enough to moderate. In our pre-debate poll, 51% supported the motion, 34% disagree with the motion, and 15% were undecided. Please be sure to vote in the post-debate motion on twitter as well! Find me @ebrheum, Dr. Dua @anisha_dua, and Dr. Fantus @sarahfantus.

Super brief "checking in" podcast this week. In short, say "hi" at ACR, write me a review on apple podcasts, send this to a friend, and keep listening :).

Today I dive into the emerging therapies for psoriatic arthritis, focusing on the IL17i ixekizumab and the recently published SPIRIT-H2H trial. It's a great combination of my favorite thing in RCTs (head to head trials) and my least favorite thing in RCTs (RCTs that were designed in such a way that they don't answer the question I want to know).

This week I revisit an old paper - the 2013 ADACTA trial that assessed tocilizumab and adalimumab for patients who cannot take or were intolerant of MTX.

This week I decided to discuss the question of HCQ and retinal toxicity. It has been controversial the past few years and we're all trying to get a handle on how to approach this. The Hopkins SLE group released this fascinating study on a large group of patients who had blood levels tracked. Worth a read and (hopefully) a listen!

Finally got around to tackling rituximab in SLE. This is a tough topic: lots of people feel passionately one way or another, flawed observational data supports its use, flawed RCTs did not find significant benefit, and patients are left in the lurch. I tried my best and came away more confident than ever that there's no clear answer. I hope you enjoy; please send me feedback on twitter @ebrheum!

This week I tackle an interesting cohort study that Jack Cush (@RheumNow) mentioned in his podcast. It's a nice opportunity to discuss bDMARDs in the "real world" (AKA Sweden). Follow me @ebrheum and let me know what you think of the episode!

Finally got around to tackling the JAKi this week. I decided to focus on SELECT-COMPARE, which pitted upadacitinib (selective JAK1 inhibitor) against adalimumab and placebo. I briefly discuss other JAKs and my thoughts on the future of this area. Get the paper and others at ebrheum.com and follow me @ebrheum!

Back this week to discuss an interesting paper in the NEJM. Lots of interesting issues, most notably historical controls and their limitations. Find all my work at ebrheum.com!

This week I'll discuss an important paper in systemic sclerosis, the recent SENSCIS trial that compared 150mg nitedanib to placebo. I wind up coming down pretty hard on this drug; I think it's hype has vastly outpaced its utility. Get the paper itself at ebrheum.com and follow me on @ebrheum to give feedback!

Welcome back! This is the second episode of Rheum4Debate, an oxford-style debate show for the field of rheumatology. In this podcast we'll tackle the question of bactrim prophylaxis in patients receiving cyclophosphamide. The motion was: “Bactrim prophylaxis should be prescribed to all patients with SLE who are receiving cytoxan and over 20mg of prednisone daily” Dr. Pankti Reid (@panktireid) argued FOR the motion and Dr. Anisha Dua (@anisha_dua) argued AGAINST the motion. PLEASE be sure to fill out the post debate poll and let us know what you think! You can find it on my twitter account @ebrheum!

Exciting episode this week! This is the FIRST of a new podcast series entitled Rheum4Debate, an Oxford style debate show for the field of rheumatology. We are planning to release one episode a month; each have a moderator and one physician on each side of a controversial motion. Be sure to VOTE on whether you agree or disagree with the motion AFTER you have listened to the podcast! Get the episode at ebrheum.com!

This week a nice case control study out of Mayo challenged my own bias against MTX in GCA. This prompted a deep dive into the literature, including 3 RCTs and meta analysis. At the end of the day, I'm more (almost) fully convinced that MTX offers a (mediocre) benefit. Follow me on twitter (@ebrheum) to share your thoughts and find all of the PDFs at my Box on ebrheum.com.

The FDA recently approved romosozumab for high risk post menopausal osteoporosis, but gave it a black box warning for cardiovascular disease. This week I'll cover the data that led to it's approval despite such dire warnings. Get the papers themselves here and be sure to follow the podcast on twitter @ebrheum or sign up with your favorite podcast aggregator at ebrheum.com

This week I pair the recently published TRACE-RA trial assessing the efficacy of atorvastatin in primary prevention of cardiovascular disease. It offered a great opportunity to also go after the recent Nature publication "Scientists rise up against statistical significance," which has (inexplicably) gotten so much high praise. Subscribe to the podcast / my twitter feed and find the papers at ebrheum.com!

This week I discuss the phase 2 trial on baricitinib in SLE. Though it's early times (and the total flop of rituxan in ME/CFS recently can attest to this), this was a large phase 2 and I'm hopeful it carries through to the ongoing phase 3 trials. Follow me on twitter and find all the papers / links at my new landing page, ebrheum.com!

#RheumJC week! I hope you all tuned into the online journal club #RheumJC, but if you did not I put up a podcast about the paper we discussed. Yet another epidemiological misadventure into unmeasured confounding and in this case confounding by indication. Take home... maybe consider not using Tramadol, as you already should have not been doing? Article I reference in the podcast: https://emcrit.org/toxhound/tramadont/ All the papers! https://tinyurl.com/yyll5qof Follow me @EBRheum.

In this week's episode I depart briefly from discussing papers in the rheumatology literature to dive headfirst into the recent controversy over eggs and cardiovascular disease. Our patients eat eggs too, so I figured it would still be applicable. Please join the conversation @EBRheum! Find all the papers here: https://tinyurl.com/yyll5qof

This week I'll tackle an interesting topic in giant cell vasculitis - the utility of FDG PET. This was a good paper but one that I used to discuss important concepts, including negative predictive value and pretest probability. Hope you enjoy! Please give feedback @EBRheum! Find all the papers here: https://tinyurl.com/yyll5qof

Finally addressing this ultrasound business. I decided to cover two somewhat similar trials, which seem to come to the same conclusions regarding U/S and treat to target strategies. However, the question addressed was narrow and the role of ultrasound remains to be determined. Get this paper (and all the others) here: https://tinyurl.com/yyll5qof

This week we tackle two RCTs and try to figure out what to do with etanercept, methotrexate, and placebo (or the lack thereof). Good opportunity for jumping into more PsA trials in the near future - lots of IL-somethings to talk about! Remember to follow the podcast @EBRheum to give feedback and for updates!

We're back! This week I discuss work I did for the rheumatology winter clinical symposium on the quality of RCTs in the rheumatologic literature. Be sure to follow the twitter handle for a descriptive slide and to weigh in on the podcast! @ebrheum