The third round of RheumMadness 2025 (the IgG Four) is out! 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.
Results from the fourth and final round will be released on April 7, 2025.
First Matchup: CD40L in Sjogren’s defeats TYK2 in SLE
The Blue Ribbon Panel chose CD40L in Sjogren’s over TYK2 in SLE in a in a 5-2 vote. Participants appeared to agree with this decision, with 27% picking CD40L in Sjogren’s to win this round versus 14% picking TYK2 in SLE. Of course, most participants picked BiTEs (46%), which lost in a shocking upset in the previous round.
Hear the opinion of the panelists in favor of CD40L in Sjogren’s below:
- This was a tough call for me. Both fulfill the “innovation” theme. But I will go with CD40L because of unmet need. From nothing to something. Already a lot of players in SLE (not that we don’t need more options, but at least they already have something) Also because SLE already gets a vote in the other branch.
- Blocking CD40 is a new and “innovative” way to treat Sjogren’s. Sjogren’s has also lacked a drug that is specific for treating Sjogren’s. Hopefully, DAZ will live up to our expectations. TYK2 was a close second choice. TYK2 has a tract record for treating plaque psoriasis but the increase in rash, especially acne may be a barrier for young women with other choices.
- The TYK2 trial was an excellent contender for its ability to succeed in multiple domains. Dazodalibep wins this match-up, however, as its study population in Sjogren’s is in greater need of a therapeutic option and its study design includes the ESSPRI, to show benefit in both systemic disease and symptom burden
- While there a few treatments in SLE, there are virtually none in Sjogren’s, especially for patients without life-threatening disease. The visual aid for the CD40L team is fantastic as well.
In contrast, the two panelists who voted in favor of TYK2 in SLE had this to say:
- Like previous rounds – a new agent in SLE that has great date beats a study with variable outcomes by patient subtype (even if very cool biology and exciting to see some targeted therapy in SS)
- Both studies were engaging, but the TYK2 inhibitor stood out as a particularly intriguing option for lupus treatment. Its oral administration and unique mechanism of action make it an exciting potential therapy. The graphic, while not basketball-themed, was clear and effectively conveyed the key points, making the study easy to follow. What really made the study engaging, though, was how fun it was to read. The writing was highly engaging, almost reading like an advertisement drawing in our attention and making the findings feel exciting. I think it was one of the most well-written scouting events for this year, had many creative puns and basketball references.
Second Matchup: Pred dose in SLE defeats Obinutuzumab in LN
Another round, another shocking upset! The Blue Ribbon Panel chose pred dose in SLE over obinutuzumab in LN in a 4-3 vote. In contrast, 19% of participants chose obinutuzumab, compared with just 8% picking pred dose in SLE. Similar to the other matchup, an overwhelming majority of participants picked CD-19 CAR T cells, which lost in the first round.
Hear what the panelists in favor of pred dose in SLE had to say:
- For many years I have wanted to see documentation that we could treat our patients with lupus nephritis effectively with lower doses of corticosteroids. As newer and better medications are developed to treat lupus nephritis, we need the data to give us the confidence to treat with lower doses of corticosteroids. Obinutuzumab was tested against “standard therapy” but voclosporin and benlysta were not included. I understand why but these two drugs have improved the prognosis in patients with lupus nephritis, without trials, it is hard to know which regimen is”better”.
- New agent in LN is exciting but lets face it, steroids are here to stay and understanding the risks and benefits is immediately important to all LN patients, like tomorrow.
- The steroid dosing study in lupus nephritis provided strong evidence through a systematic review, addressing a question we frequently face in clinical practice. Finding the right steroid dosing for LN patients is always a challenge, and it’s great that this study tries to provide suggestions based on the current data. Steroids are essential for treatment, but their toxicity is a well-known concern, so having better guidance benefits both patients and providers. The graphic in this scouting report is incredibly eye-catching, stands out, and is one of the best we’ve seen this year. It’s not only engaging but also illustrated the key information in a fun and direct way, making it memorable and easy to apply in clinical practice.
- Pred dose wins as an issue that is exceptionally important now and will continue being even more important in the future. The visual tool this created is the MVP.
In contrast, those in favor of obinutuzumab said this:
- Prednisone dosing in lupus nephritis is an incredibly important topic to highlight and continually revisit in our practice pattern. This has led it on an incredible Cinderella run against more modern therapeutic options. Though important, I vote to end their run given the superior study designs of other trials. A meta-analysis is a helpful way to combine multiple RCTs, but does face variability between various studies at different times. Obinutuzumab was submitted with a well-designed phase 2 randomized, double-blind, placebo-controlled study, with a phase 3 trial now hot off the presses.
- Another tough call, but I will just stick to the theme of “Innovation”. The Prednisone dose in SLE seems more like a “Validation” of something we already do based on clinical experience, rather than an “Innovation”
- One vote submitted without comment (they must have felt the study spoke for itself!)
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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).
