Mike Putman Profile picture
Aug 5 5 tweets 3 min read
Epic editorial just published in @jrheum re:@ACRheum 2019 osteoarthritis recommendations

In short, ACR took the (correct!) stance that we should recommend AGAINST hyaluronic acid

This somewhat understandably upset companies that produce this voodoo. So they wrote an editorial!
Right up front, we get the "I'm not biased, you're biased!" accusation

It's pretty rich for authors who literally worked for and actively own stock in OrthogenRx (a purveyor of fine hyaluronic acid) accuse others of "bias"

Oh, also, OrthogenRx "funded" this editorial
Really - who needs funding to write an editorial? It's like 1200 words and a figure. I've written tweetorials that long while driving

I suppose it was nice to have AOIC LLC, which OrthogenRx funded, make your figure, edit your paper, add refs, and submit the article
This sentence goes down in the #EBM pantheon

The day I spend time reading a "metaanalysis of 12 overlapping metaanalyses" is the day I quite medicine and start up a snake oil company

What does it even mean to meta analyze a dozen meta analyses?
Really though I'm thankful to AOIC LLC for the figure they made

Mostly because I'm proud of the ACR for standing up for #EBM

It aptly illustrates how much courage that takes and how divergent the conclusions of a guideline committee that relies on EBM can be

Kudos ACR.

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More from @EBRheum

Jan 27
ORAL Surveillance, open label RCT of tofa vs. TNF, published @NEJM, aka Sword of Damocles has finally fallen

In short, TOFA associated with ⬆️ risk of major adverse cardiac events (MACE) (HR 1.33, CI 0.91-1.94) & ⬆️ risk of cancer (HR 1.48, CI 1.04-2.09)

Much to unpack, a 🧵
1/This was an OPEN label RCT of tofacitinib (JAKi), which randomized pts to 10mg tofa : 5mg tofa : TNFi (ada or etn) in a 1:1:1 ratio

Included patients had RA, were mostly female (80%) / white (75%), & all had at least 1 RF for cardiovascular disease
3/ Coprimary endpts =

1. MACE (CV death, nonfatal MI, nonfatal stroke)
2. Cancers (excl nonmelanoma skin dx)

These are RARE endpts; power calculation required 4000 total & >1500 patients w/3 years of f/u

Noninferiority: HR 1.8 for MACE and 2.0 for CA, seems reasonable?
Read 13 tweets
Jun 3, 2020
HCQ for COVID-19 prophylaxis RCT, @NEJM

Self reported exposed patients received HCQ or PLBO

No significant difference in rate of developing COVID-19 (11.8% HCQ vs 14.3% PLBO, p = 0.35)

Overall suggests HCQ for post exposure trophy does not work. But I have some concerns...
1/ KUDOS to the authors for doing this, but when subjects were asked if they got HCQ or PLBO:

HCQ grp: 47% guessed HCQ, 10% PLBO, (others unsure)
PLBO grp: 17% guessed HCQ, 36% PLBO, (others unsure)

That's a fair bit of unmasking, threatens validity of randomization
2/ Interesting issues with selection - social media recruitment, lots of screened peopled excluded (~6,000), mostly healthcare workers, self report exposure. Randomization should fix some of this, but it was not "all comers." This makes issue 1 (unmasking) extra problematic to me
Read 5 tweets

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