The second round of RheumMadness 2025 (the entheseal eight) is full of more upsets!   See how the Blue Ribbon Panel voted below, along with written explanations for how they made their picks. You can also check out how your bracket is doing on the tourneytopia website.

To hear a full round up of how participants voted, give our most recent RheumMadness podcast episode a listen.

Results from additional rounds will be released as follows:

• Round 3 (the IgG Four): April 5
• Round 4 (the Interleukin Two): April 7

First Matchup: CD40L in Sjogren’s defeats BiTEs

Another massive upset!  The Blue Ribbon Panel chose CD40L in Sjogren’s over BiTEs in a in a 4-3 vote.  This was shocking, as 58% of participants thought BiTEs would win this round, compared with 34% choosing CDL40L and 8% sticking with APIPPRA.

Hear the opinion of the panelists in favor of CD40L in Sjogren’s below:

• Both studies were innovative, with the BiTE study showing promise as a new treatment approach. However, the CD40 ligand study in Sjögren’s disease stood out as one of the few trials to demonstrate a meaningful improvement in sicca symptoms, addressing a long-standing unmet treatment need. It also provided a stronger level of evidence. At this stage, we believe the CD40 ligand study offers more immediate guidance for physicians and benefits for patients. The study’s visual presentation was particularly compelling, using the Sjögren’s horse wordplay to add a creative and memorable touch. Overall, the infographic and scouting report presented an innovative treatment option for Sjogren’s in a way that was both engaging and easy to interpret.
• This match-up is an early scouting of two exciting young prospects with a match-up of a case report against a phase 2 trial. Both have great potential, though the more robust findings in the dazodalibep brings this one further, especially when bolstered by the exciting inclusion of subjective and objective endpoints in Sjogren’s disease.
• Tough decision, but at this time I am leaning towards CD40L in Sjogren’s due to currently limited options to help treat Sjogren’s disease patients.
• This is a close call for me – both fit what im looking for in terms of the theme of Innovation. Im going for CD40L because there is an unmet need (like absolutely nothing solid) while SLE already has a lot of players on the field.

In contrast, here’s the opinion of those who voted for BiTEs:

• CD40L for Sjogren’s is good but there is potential to dramatically improve the treatment of several autoimmune diseases with BiTes. In fact, one of the studies looked at the use of BiTes in Sjogren’s. I feel BiTes have the potential to do the greatest good for the greatest number of people.
• What a difficult match-up! Both reports are excellent and the visual aid for CD40L inhibitor is fantastic. However, BiTEs is such an exciting and promising treatment, that appears to be more accessible and safe that CAR-T cell, that I had to pick that.
• LOVE BITES! The idea is so elegant The antibodies are “off the shelf.” The toxicity is low. THEY WORKED. The CD40L study is preliminary and the results heterogeneous – unlikely to be a game changer. BITEs all the way

Second Matchup: TYK2 in SLE defeats Oral anti-IL23

The Blue Ribbon Panel chose TYK2 in SLE over Oral Anti-IL23 in a 6-1 vote.  This was not an upset, as 49% of participants chose TYK2 in SLE, 36% chose oral anti-IL23, and 14% chose the long-term extension of anifrolumab.

Hear those in favor of TYK2 in SLE below:

• While oral IL-23 has great benefit for skin disease in psoriasis, the TYK2 wins this one as it hits not only skin but multiple lupus domains.
• Oral anti-IL23 drugs would be the second oral drug for psoriasis. So it is not quite as innovative as TYK2 for SLE. The joint and skin manifestations of SLE can be very difficult to treat and a new oral drug that is steroid sparing would be welcome. We may be pleasantly surprised that more good things will come with this unique drug.
• Novel therapy in SLE to help better control disease would be great, considering the limited options at this time.
• Another difficult match-up . Both reports and visual aids are great. Picking TYK2 as a more impactful paper. We do not have enough safe effective treatments in SLE, while psoriasis now has drug that achieve complete skin clearance potentially (e.g., bimekizumab).
• This one was difficult for me – because both fit the criteria of Innovative-“ness” and both have the potential to be scalable. I’m just going to vote for TYK2 only because I think the oral anti-IL23 is too early a contender.
• Both are great studies with exciting results and new class BUT the unmet need in SLE is greater (and the morbidity of SLE > PsA) and the TYK2 look so good. PsA has plenty of effective treatments already and I guess PO is nice but……a new agent for SLE – champion

In contrast, here’s the lone dissenting opinion in favor of Oral Anti-IL23

• Both studies were innovative and aimed at expanding treatment options in Rheumatology which would benefit both providers and patients. Although, the oral anti-IL-23 study focused solely on cutaneous involvement, it introduced an oral treatment with efficacy comparable to standard therapy and has a better safety profile than other available oral medications. The graphic was exceptionally well-designed, making complex information easy to digest. Adding the little players was a clever and engaging touch, allowing for a quick comparison of treatment options and clearly highlighting the advantages of this new oral medication over existing alternatives.

Third Matchup: Pred dose in SLE defeats SGCAPS

Another upset!  The Blue Ribbon Panel overwhelmingly favored pred dose in SLE, voting for them over SGCAPS in a 6-1 blowout.  However, 49% of participants chose SGCAPS compared with 36% picking pred dose in SLE and 14% for HCQ screen cost.

Here’s what the panelists in favor of pred dose in SLE had to say:

• While the SGCAPs study proposed a scoring system to guide the management of GCA. The steroid dosing study in lupus nephritis provided stronger evidence as a systematic review. It addressed a crucial and frequently debated question in rheumatology. The optimal steroid dosing in LN patient is a challenge we often encounter in clinical practice, making the study particularly relevant. The graphic was exceptionally well-designed, engaging, and fun presenting the suggested dosing in a clear way. It made the information easy to remember and ready for application in real-world scenarios.
• Prednisone in lupus nephritis tackles one of the most fundamental problems in rheumatology – balancing the incredibly challenging risk/benefits of our love/hate medication. This is widely applicable with very high utility. SGCAPS is a great study, though difficulty in ultrasound reliability without proper experience and training makes it less broadly applicable.
• Pred dose SLE, We need as much evidence as possible that we no longer need large doses of corticosteroids. This is a welcome study. I found the SGCAPS intriguing but am concerned that other than large medical centers, there will not be adequate number of people with expertise to do the ultrasounds in a timely basis. This may be another case of disparity in care by where you live.
• Steroid mindfulness (pred dose in SLE) wins. SGCAPS report is excellent and their visual tool is one of the best in this competition. However, being thoughtful about prednisone dosing is what any rheumatologist in any practice setting can and MUST do; while ultrasound is a luxury not available to most of us, at least in the US.
• Innovation won’t be important if it won’t be scalable. While ultrasound use has been around for ten years, many countries still have yet to make it a standard part of curriculum. Therefore I don’t see the SGCAPS affecting clinical practice. While the Pred dose in SLE doesn’t seem new… and is a part of clinical intuition, it’s innovative in the sense that it did a rigorous analysis of current practice.
• The Pred dose in SLE study provides essential information to inform shared decision making for SLE. The SGCAPS just makes everyone who cannot access ultrasound for GCA feel bad!

In contrast, the lone panelist in favor of SGCAPS said this:

• Both of these are great trials- landmark paper about damage accrual in SLE patients on Prednisone vs new tool to help guide GCA management. It is definitely a tough call! I am leaning towards SGCAPS, the challenges of reliable GCA diagnosis guiding subsequent immunosuppressive therapy in elderly populations could benefit from innovative strides at this time.

Fourth Matchup: Obinutuzumab in LN defeats the STRAP trial

The blue ribbon panel chose obitnutuzumab in lupus nephritis over the STRAP trial in a 5-2 vote.  Of the remaining options, most participants agreed with 29% picking obinutuzumab versus 19% favoring STRAP in this round (nothing that 52% still thought CAR-T would still be in it and win this round!).

Those in favor of obinutuzumab in LN said this:

• The STRAP trial is a good idea but the results were underwhelming. The added expertise to do the synovial biopsies and the expense of reading these biopsies limits the potential as a future “guiding light”. Obinutuzumab looks exciting for SLE. This was my choice but I still have some reservations as there were no comparisons. I would like to know how many patients in the trial had previously been on voclosporin or belimumab. And how obinutuzumab compares to these two drugs.
• While I was initially leaning heavily towards the STRAP trial as it could potentially change the whole RA management landscape, I feel we need to use this time to gather stronger and more convincing data. Between these two trials, I favor the Obinutuzumab in LN intervention in terms of applicability. Both are great and monumental shifts in Rheumatology!
• I absolutely love it that our European colleagues are participating and, as a person not terribly well versed in American spots, I appreciate them just not sticking to basketball puns. The visual tool is beautiful too. However, as a practical clinician, I am picking Obinutuzumab as I see it using in my practice much sooner than synovial biopsies.
• Innovation won’t be important if it won’t be scalable. Obinutuzumab has the potential for a broader and more immediate clinical workflow impact & can be readily integrated to practice
• The STRAP trial sounds so enticing in the protocol but lack difference in ACR20 response and no actionable findings. Finding a B cell depletor that actually improves rates of remission in Lupus nephritis – GOLD

In contrast, the two panelists in favor of STRAP said this:

• Although the STRAP trial was ultimately negative, we were impressed by the team’s forward-thinking approach in selecting an article that discussed precision medicine and the opportunity to make our targeted therapies truly targeted. While the scouting report and graphic weren’t basketball-oriented, they still demonstrated more creativity compared to the Obinutuzumab in LN article. It’s clear that a lot of effort went into the STRAP trial presentation.
• In a bracket of innovation, STRAP trial breaks the mold of our other traditional drug trials by seeking to find new ways to compare our existing medications. I love the design of using synovial biopsies to better understand patient phenotype and strive for a future of patient-centric care.

So, how’s your bracket doing? We want to know! Here’s how to connect with us:

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Remember, you can also find practical Q&As about each topic on theMednet.org! Links are included in each scouting report (find them here).