Rheumatology Journal Club Debut: The Twitter Conversation Condensed

Feb 03, 2015

Even if you missed participating in the first-ever rheumatology journal club on Twitter last week at #rheumjc, you can relive the conversation, condensed and edited, in fewer than a dozen slides.

Still not tweeting? Rheumatologists not yet on Twitter missed chance to join their peers in the debut of the first rheumatology journal club, #RheumJC.You may have missed it, but you don't need to miss out. The lively discussion of a study on lupus nephritis treatment is condensed and compiled for you here, in fewer than a dozen slides.[[{"type":"media","view_mode":"media_crop","fid":"31307","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_219536787044","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3298","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 141px; height: 127px; float: right; margin: 3px;","title":"","typeof":"foaf:Image"}}]] Several nephrologists joined the discussion.The journal club conversation took place in two sessions (but the venue was open for comments inbetween) on January 29. Statistics show more than 500 responses, evenly divided between the two sessions.As always on Twitter, all comments were shorter than 140 characters in length (including the hashtage #rheumjc)."So much more fun than a regular JC," responded one participant afterwards, and another called it "the most lively journal club i've participated in a long time!"(Comments are reprinted as submitted, with many common words abbreviated for brevity by participants.)

In a study comparing mycophenolate mofetil with tacrolimus for induction treatment of lupus nephritis, the latter drug proved more effective at reducing proteinuria after 6 months.Mok CC, Ying KY, Yim CW et al, Tacrolimus versus mycophenolate mofetil for induction therapy of lupus nephritis: a randomised controlled trial and long-term follow-up Ann Rheum Dis doi:10.1136/annrheumdis-2014-206456. Published online first 30 Dec 2014

Why use anything other than the recommended regimen for lupus nepritis induction: mycophenolate mofetil or cyclophosphamide? MMF is contraindicated in pregnancy, some patients can't tolerate it -- and tacrolimus may be less costly.

Nephrologists weighed in with their concerns about tacrolimus. Due to its known risk of nephrotoxocity, some are looking for alternatives.

How many rheumatologists are using tacrolimus, and how? Some in this discussion use it for class 5 lupus nephritis, usually as an add-on, never (yet) for the proliferative form.Image: Tacrolimus (Credit: Benjah-bmm27, Ben Mills)

Participants discuss their favored regimens for lupus nephritis induction. Most use mycophenolate mofetil for at least six months, sometimes azathioprine for maintenance.Image credit: Tomascastelazo

Tweeting rheumatologists commented on the study design. Most felt the primary endpoint (proteinuria reduction) was weak and criticized the researchers for lumping all classes of nephritis together in one group.

Another topic of discussion: Ethnicity. This study included only people of Chinese descent. Is that relevant to others, particularly when genotype can affect drug metabolism and the severity of lupus?

One participant posted a map showing that all trials of tacrolimus for lupus nephritis are taking place in Southeast Asia. Image source: https://clinicaltrials.gov/ct2/results/map?term=lupus+nephritis+tacrolimus

Journal club comments on the results: Complete remission (proteinuria

Finally, a surprise from the data: Beyond 6 months, mycophenolate mofetil actually showed better results than tacrolimus. Was the study under-powered to show a benefit for MMF at all time points?

The bottom line: Would this change the practices of these rheumatologists? (Probably not much, but they're intrigued by tacrolimus and want to know more.)