ADARRC

The U.S. Food and Drug Administration (FDA) has approved Saphnelo™ (anifrolumab-fnia) as a treatment for adults with systemic lupus erythematosus (SLE) who are receiving standard therapy. It is the third U.S. FDA approval of a lupus therapy since 2011, expanding treatment options for this medically underserved and life-threatening autoimmune disease.Saphnelo inhibits a key protein in the immune system called the IFNAR receptor that acts as a transmitter, amplifying signals from tiny messengers called type I interferons. This process activates many parts of the immune system and can trigger major inflammation. Saphnelo dampens the excessive type I interferon signature found in [...]

How accurate are rapid antigen tests for COVID-19 in both asymptomatic and symptomatic patients? A rapid antigen test (Sofia FIA from Quidel) was highly specific, but sensitivity was 80% in symptomatic patients and only 40% in asymptomatic patients. In asymptomatic patients, due to the low prevalence in this sample (2%), there was also a high false positive rate of 67%. Pray IW, Ford L, Cole D, et al, for the CDC COVID-19 Surge Laboratory Group. Performance of an antigen-based test for asymptomatic and symptomatic SARS-CoV-2 testing at two university campuses - Wisconsin, September-October 2020. MMWR Morb Mortal Wkly Rep 2021;69(5152):1642–1647. [...]

For patients with sciatica, do epidural corticosteroid injections safely reduce pain and disability? Epidural corticosteroid injections provide a small and probably clinically insignificant reduction in leg and back pain in the immediate term (< 2 weeks), and a small to moderate reduction in disability in the short to intermediate term. Adverse events and safety were not well reported. Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for sciatica an abridged cochrane systematic review and meta-analysis. Spine 2020;45(21):E1405-E1415.

Are ultrasound-guided intra-articular steroid injections more accurate than blind injections? In this study from at a single center where steroid injections were given by a single experienced clinician, ultrasound (US)-guided intra-articular injections were more accurate than blind injection. But the outcomes, even among those that "missed," were similar. Cho CH, Min BW, Bae KC, Lee KJ, Kim DH. A prospective double-blind randomized trial on ultrasound-guided versus blind intra-articular corticosteroid injections for primary frozen shoulder. Bone Joint J 2021;103-B(2):353-359.

Does convalescent plasma improve outcomes in patients hospitalized with severe pneumonia due to SARS-CoV-2? In this study, convalescent plasma did not improve outcomes in patients hospitalized with severe COVID-19 pneumonia. Simonovich VA, Burgos Pratx LD, Scibona P, et al, for the PlasmAr Study Group. A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med 2021;384(7):619-629.

Does Tofacitinib Increase the Risk of Venous Thromboembolism in Patients with RA? Recently, a link between venous thromboembolism (VTE) and Janus Kinase (JAK) inhibitors has emerged, causing the FDA to recommend a black box label for tofacitinib in 2019. New research, however, suggests that tofacitinib had similarly infrequent cases of VTE (<1 per 100) when compared with tumor necrosis factor inhibitors (TNFIs). Desai RJ, Pawar A, Khosrow-Khavar F, Weinblatt ME, Kim SC. Risk of venous thromboembolism associated with tofacitinib in patients with rheumatoid arthritis: a population-based cohort study [published online ahead of print, 2021 Mar 22]. Rheumatology (Oxford). 2021;keab294. [...]

Are monoclonal antibodies against the interleukin-6 receptor effective in patients who are critically ill with COVID-19? In patients who are critically ill with COVID-19 and require respiratory or cardiovascular organ support, the monocloncal antibodies tocilizumab and sarilumab reduce mortality (number needed to treat [NNT] = 12) and decrease the need for organ support during the 3 weeks following the initiation of therapy. As we have seen with other studies of COVID-19 therapies, benefit is often restricted to specific groups, and this result should not be generalized to less ill patients for whom the benefit has not been demonstrated. The [...]

For acute muscle pain, what oral analgesic provides the best immediate relief? A single dose of opioid analgesics provides similar acute pain relief to a single dose of a combination of acetaminophen and ibuprofen in patients with acute musculoskeletal pain in the emergency department. Opioids increase the likelihood of nausea or vomiting. There was no added benefit of 800 mg of ibuprofen as compared with 400 mg. Unfortunately, the study did not investigate the further effect, possibly because of the placebo effect, of an injectable analgesic. These results are similar to those of previous studies of opioids and different doses [...]

What interventions are effective in managing patients with chronic low back pain? The interventions that are better than control in achieving at least a 30% reduction in pain are exercise, oral nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, and opioids, but discontinuations of the latter 2 treatments were common. Lower-quality data suggest that manipulation and topical capsaicin are also effective. Finally, it is possible the authors' inclusion criteria missed important studies. Kolber MR, Ton J, Thomas B, et al. PEER systematic review of randomized controlled trials: Management of chronic low back pain in primary care. Can Fam Physician 2021;67(1):e20-e30. [...]

Is electroacupuncture safe and effective in the treatment of adults with chronic low back pain? This study found mixed results on the benefits of electroacupuncture in treating adults with chronic low back pain. Although no significant difference occurred between active and sham therapy for the primary outcome of reduced pain, a secondary outcome of reduced disability was significantly improved with active versus sham therapy. In addition, eliminating one single significant outlier from the overall analysis resulted in a significant benefit of active electroacupuncture versus sham therapy in both reducing pain and disability. Kong JT, Puetz C, Tian [...]