Round 2 Results

The results of the Entheseal 8 (round 2) are here!  To see how your bracket is doing, head over to the RheumMadness Tourneytopia website.

This round had even more chaos than the seronegative 16!  The majority of participants disagreed with the Blue Ribbon Panel (BRP) on the winners of the Milieu Modifiers region and Rheumatoid Rumble regions, and the most popular participant pick to win the Tailoring Treatment region (ARCTIC REWIND) didn’t even make it to this matchup!  The only region with any semblance of harmony was Landmark Layups, were the majority of participants agreed with the panel on SAPHYR heading into the IgG-Four.

Full results for reach matchup in the first round are reviewed below, including how the panel voted compared to participant picks. Huge thanks to our amazing panel for their thoughtful consideration.

Matchup 1: ADIRA defeats COVID Vax Guide, 4-3

Overall, participants DISAGREED with the panel, with 47% of participants picking COVID Vax Guide as the winner of this region, followed by ADIRA (20%), Precision OA (19%), and VITAL (14%).

Comments from the Blue Ribbon Panel in favor of ADIRA

  1. ADIRA is a really informative clinical trial as I said in the previous round
  2. hot, hot topic! Diet changes empower the patient to improve disease control without medications – EVERY patient asks about diet changes – and its great to have evidence for this intervention
  3. Adira edges COVID by a hair. Both papers are practical and important. However, Adira’s graphic is more professional-looking.
  4. The clinical question asked in ADIRA — whether an “anti-inflammatory diet” improves disease activity scores in patients with rheumatoid arthritis — is something we have all been asked directly by our patients. In my mind the answer after reading this trial is still “maybe,” as the main analyses did not show significant differences between the control and intervention groups, there were no significant differences in the components of DAS28-ESR, and sample size was quite small. But it does address a clinically relevant question and open the door for further investigators to explore it. And bonus points for all the sports-related puns. The COVID Vax Guide is practical, but the guidance on these issues is ever-changing, and for several medications the article is unable to call upon good evidence to support or refute the recommendations it presents. There are also multiple authors on the study with ties to companies that produce vaccines (e.g. Pfizer).

Comments from the Blue Ribbon Panel in favor of COVID Vax Guide:

  1. In terms of importance to the world of rheum madness, The COVID Vax guide has been the epicenter of the rheum world for the last 3-4 years. Its fluidity of change and adaptability to circumstances has been unseen by other guides in the realm. ADIRA puts up a good fight, but the matchup zone placed by the Vax guide is too much to handle.
  2. Very difficult matchup, but it came down to the last few seconds of the shot clock. I imagined what we would be able to do without each study and determined that without ADIRA we would still be able to encourage a healthier diet which would have an impact on the patient’s disease, but without the Vax Guide, we may not have been able to figure out what to do with the various medications we use in rheumatology. Hence, more impact.
  3. Vaccine guidance for the win.


Match-up 2: EMBRACE Defeats GCA Score 4-3

Once again, the majority of participants DISAGREED with the panel, with 46% picking ARCTIC REWIND to win this region, followed by EMBRACE (21%), LLDAS (19%), and GCA Score (14%).

Comments from the Blue Ribbon Panel in favor of EMBRACE:

  1. EMBRACE is a randomized controlled trial that provides high quality evidence for an important research question
  2. Landmark trial to enroll patients of Black race – opens the field to addressing disparities in health care
  3. EMBRACE is an important study. The removal of the cautionary statement was important. GCA Score is helpful, but its value is limited by the small sample size, which led to several clinical features rarely being seen (and therefore difficult to evaluate reliably). A multicenter validation study would be more useful.
  4. Landmark trial to enroll patients of Black race – opens the field to addressing disparities in health care

Comments from the Blue Ribbon Panel in favor of GCA Score:

  1. Both are important, but I think for lack of treatment options in SLE, we would have used belimumab for black patients in lupus still and observed that it was beneficial so not sure that it changes practice beyond confirming its benefits. I think the absence of the GCA score has a greater impact on the way we approach the diagnosis and can save many elderly persons from exposure to high-dose steroids and its complications.
  2. This is a difficult tight match up in the Entheseal 8. Both studies have high merit points in very different sectors of research. The social ramifications of the EMBRACE trial cannot be understated but belimumab is well studied and shown to be helpful prior to focusing on ethnic populations. Having an assist in the diagnosis of GCA is the alley hoop that rheumies have been waiting for many years and its validation could revamp the diagnosis game in GCA. I give it the nod on that factor. Unfortunately, Coach Ginzler with her historic record goes down in her final game.
  3. 1. GCA taught me something new as I do not get Clinical and Experimental Rheumatology 2. GCA graphic was very practical and straight to the point. EMBRACE had a lot of important points on their graphic but it was too wordy for the points you were making. 3. Both write ups were good. However, GCA cleverly included basketball terms (keeping to the theme of March Madness) that everyone can recognize (tying in the Rheum Madness with their write up). 4. I wish EMBRACE would have mentioned where the letters EMBRACE come from to make the acronym easy to remember 5. The GCA score is very practical, while belimumab has been out for over a decade and studies like the “real-world” OBSERVE trial demonstrated usefulness in our African ancestry population a long time ago


Match-up 3: SAPHYR Score defeats PRODERM, 5-2

Finally, the participants and the panel agreed, with 36% of participants picking SAPHYR to win this region, followed by PRODERM (26%), Comparing ULT (25%), and INBUILD (13%).

Comments from the Blue Ribbon Panel in favor of SAPHYR:

  1. Another close matchup. Both studies result in the first offensive weapon approved for two rare defensive nightmares. One more potent but rare and one bothersome but common. The offense that overpowers the common defense has more impact on a global scale than the rare design and thus would favor SAPHYR. This does not diminish the utility of the rare offensive prowess of PRODERM.
  2. As I had stated in the previous round, PRODERM did not change clinical practice for myositis, everyone was already using IVIG for management of myositis
  3. There are multiple options for treatment of dermatomyositis and IVIG was being used off-label so we already knew it’s impact and it confirmed this. Add to this, it’s relatively rare compared to PMR where the diagnosis sentenced our patients to prolonged steroid exposure with a few off-label alternatives, but nothing in the biologic space until now. It’s a big game-changer for the demographic affected by PMR to prevent side-effects from steroids.
  4. addresses a huge unmet need in PMR where all we have is glucocorticoids.
  5. Another great option in PMR

Comments from the Blue Ribbon Panel in favor of PRODERM:

  1. PRODERM was a much-needed trial that has allowed me to give IVIg to patients with dermatomyositis without first needing to have tear-inducing conversations with insurance companies. The team is right that it was a “game-changer” for rheumatologists.
  2. 1. Both papers highlight an important treatment for two diseases that do not have prior FDA-approved therapies, so I had to go solely by the graphics and write ups. 2. PRODERM graphic was simple, straight to the point, used the most important “rules” of making a graphic = use eye catching image and very few words 3. SAPHYR actually had an excellent write up except they sprinkled in many basketball terms that people who do know basketball do not know. Though it is clever to connect the write up to the theme of March Madness, the unfamiliarity with these terms detracts from getting points across to some readers. PRODERM insert every easy to understand basketball terms that everyone understands plus they had an excellent write up

Match-up 4: NORD-STAR defeats ORAL Surveillance, 4-3

Wow, this one was close.  Participants were incredibly split, but overall they DISAGREED with the panel on this one, with 32% picking ORAL Surveillance to win this region, followed by NORD-STAR (31%), MTX Myths (20%), and finally RA-ILD Review (17%).

Comments from the Blue Ribbon Panel in favor of NORD-STAR:

  1. Head to head trials in RA is very informative!
  2. 1. NORD-STAR graphic is easy to understand, to the point, professional looking. For the ORAL graphic, I’d recommend using an easier to read font. Conveying the point from the Krugstrup graphic is great, but it needs a key identifying what the colors mean. 2. The NORD-STAR write-up edges out ORAL because it was easier for me to understand. For both teams I’d recommend using terminology that all readers will understand (too much basketball terms in NORD-STAR and fencing terms in ORAL that many readers will not know).
  3. NORD-STAR challenges the “methotrexate-first” treatment paradigm for rheumatoid arthritis and provides evidence for starting a TNF inhibitor or abatacept along with methotrexate in patients who are newly diagnosed with RA. ORAL Surveillance changed the way we counsel patients about JAK inhibitors and the calculus we use when deciding whether to start these medications. However, it is difficult to read the visual accompanying the team’s scouting report.
  4. Biologic use in early RA changing treatment paradigms

Comments from the Blue Ribbon Panel in favor of ORAL Surveillance:

  1. Man this only gets tougher. One team confirms the base for the management of RA. One team completely forced reevaluation of a large program in the RCAA (Rheum comorbidity assessment association). Both make important points overall, but NORD STAR confirms known data. Oral Surveillance has resulted in mass change in dogma and scrambling to find refuting evidence to reestablish the important program that has been blacklisted. I would favor oral surveillance on importance.
  2. Again, both very important studies in RA with great clinical impact. I would say that without each of these studies, perhaps: – We would have eventually gotten to the control we needed by using a stepwise approach to treatment (NORD-STAR). – We may not have screened for risk factors for MACE and cancers prior to starting this class (ORAL Surveillance). ORAL Surveillance’s impact on how we practice is more significant.
  3. Important data on safety of JAKi with widespread implications for these therapeutic interventions.


What’s up next?

Results for the next 2 rounds will be released on the following dates:

  • Tuesday, March 26: The IgG4 (round 3)
  • Thursday, March 28: The Interleukin 2 (round 4, championship)

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