Rituximab vs. mycophenolate mofetil for pemphigus vulgaris
According to a study published in theNew England Journal of Medicine, rituximab was superior to mycophenolate mofetil (MMF) in generating complete remission at 52 weeks and reducing oral glucocorticoid use for patients with moderate-to-severe pemphigus vulgaris.
In a randomized, controlled trial, the researchers assigned 67 patients to receive intravenous rituximab (1000 mg on days 1, 15, 168, and 182) and 68 to receive oral mycophenolate mofetil (2 g per day), in addition to an oral glucocorticoid given on the same tapering schedule in the two groups. The median Pemphigus Disease Area Index (PDAI) activity scores at baseline were 22.7 in the rituximab group and 18.3 in the MMF group. At week 52, sustained complete remission was observed in 25 patients (40%) in the rituximab group and in six (10%) in the MMF group. Six disease flares occurred in the rituximab group and 44 flares occurred in the MMF group.
The average cumulative glucocorticoid dose during the treatment period was 3545 mg in the rituximab group and 5140 mg in the MMF group. Serious adverse events occurred in 22% in the rituximab group and in 15% of the MMF group.
[The potential FDA approval of multiple JAK inhibitors could offer new treatment options for dermatology patients. Read more inDermWorld.]
DermWorld Insights and Inquiries: Like the tumor itself, knowledge about DFSP is expanding wider and deeper
Dermatofibrosarcoma (DFSP) is a mystifying lesion. Although considered rare, I have encountered several cases over the years. Some recent literature offers potential insights into its pathogenesis and management.
DFSP is a low-to-intermediate grade sarcoma with a reported incidence of 4.1 per million person-years. Age at diagnosis is usually between 20 and 59 years, although it may be seen at any age, even congenitally. It is usually distributed on the trunk, more than the extremities or head and neck. DFSP is slightly more common in men and among Black people. It usually appears as a firm flesh-colored cutaneous and subcutaneous nodule(s) with slow growth. DFSPs are locally aggressive but metastasize in less than 5% of cases. The 10-year relative survival is >99%; those with a worse prognosis tend to be older, male, Black, and have lesions on the extremities and head. Keep reading!
Derm Coding Consult: Applying the 2021 E/M coding concepts in everyday practice – Part 5
In part 5, three coding vignettes are presented to demonstrate how data ordered outside or between encounters contributes to the Data to be Reviewed or Analyzed MDM element in the next encounter. Review the coding vignettes.
Methotrexate may decrease effectiveness of Pfizer-BioNTech COVID-19 vaccine
According to a study published in theAnnals of the Rheumatic Diseases, patients with immune-mediated inflammatory diseases (IMIDs) taking methotrexate, had an adversely affected humoral and cellular immune response to COVID-19 mRNA vaccines. Patients with IMID receiving the BNT162b2 mRNA vaccination were assessed at baseline and after the second immunization while healthy subjects served as controls.
While healthy subjects and IMID patients on biologic treatments (primarily TNF blockers) demonstrated robust antibody responses (over 90%), the patients with IMID on background methotrexate achieved an adequate response in only 62% of cases. IMID patients did not demonstrate an increase in CD8+ T cell activation after vaccination. The study authors conclude that different strategies may need to be explored in patients with IMID taking methotrexate to increase chances of immunization efficacy.
The American Medical Association (AMA) announced the election of California dermatologist Jack Resneck Jr., MD, as its new president-elect. Dr. Resneck will assume the office of AMA president in June 2022.
First elected to the AMA Board of Trustees in 2014, Dr. Resneck held the office of board chair from 2018 to 2019. Prior to his election, Dr. Resneck served as chair of the AMA Council on Legislation and as a delegate to the AMA House of Delegates. Additionally, he has held several leadership positions in organized medicine, including president of the California Society for Dermatology and Dermatologic Surgery, board member at the American Academy of Dermatology, and active member at the California Medical Association. Dr. Resneck has testified in congressional hearings on the topics of telemedicine, digital health, rising prescription drug prices, prior authorization, and other challenges facing the U.S. health care system.
Provider Relief Fund reporting deadline extended
If your practice received funds from the COVID-19 Provider Relief Fund, good news: HHS has announced an extended reporting period to complete the required documentation. Originally, all recipients would have had to complete their documentation during the month of July 2021, regardless of how recently they received funds. HHS has updated this requirement, creating four 90-day reporting periods. The first period, for those who received at least $10,000 in funds prior to June 30, 2020, will start July 1, 2021, and run through Sept. 30.
Need to report? Sign up for the Provider Relief Fund Reporting Portal and review the portal FAQs to learn more about what you’ll need to do once the portal opens in July.
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