Final Results and Thank You!

The fourth and final round of RheumMadness 2025 (the Interleukin Two) is out!  See how the Blue Ribbon Panel voted below, along with written explanations for how they made their picks.  Please also keep reading to see a list of participant winners and our long list of thank you-s for another great year!

You can check on the final results of your bracket on the tourneytopia website.

Round 4: CD40L in Sjogren’s defeats Pred Dose in SLE (5-2).

The panel picked the novel CD40L inhibitor in Sjogren’s trial over pred dose in SLE in a 5-2 vote.  In comparison, here is a list of which teams RheumMadness participants thought would win the tournament according to bracket submissions.

  • CD19 CAR-T: 29%
  • BiTEs: 24%
  • STRAP Trial: 12%
  • TYK2 in SLE: 9%
  • CD40L in Sjogren’s: 6%
  • Obinutuzumab in LN: 6%
  • Pred dose in SLE: 5%
  • Oral anti-IL23: 4$
  • Anifrolumab extension: 2%
  • SGCAPS: 2%
  • ABA in Pre-RA: 0%
  • HCQ Screen Cost: 0%

Here’s what the Blue Ribbon Panel had to say in favor of CD40L in Sjogren’s:

  • CD40L inhibitor study explores a novel therapy. This strongly aligns with the definition of innovation. The development of a therapy that could modify the disease course represents a major step forward, fulfilling an unmet need. (Something out of nothing!) And it has the potential for a global impact. (Scalable!) Pred dose study is primarily dealing with the optimization of an established cornerstone therapy rather than introducing a new treatment approach.
  • This was an extremely difficult choice. Sjogren’s is a disease with no approved treatments. I liked the fact that the trial addressed both disease activity and symptoms. The pred dose trial addressed a problem that we have dealt with since the birth of rheumatology. Rheumatologists are becoming comfortable with using lower doses of corticosteroids in treating our diseases as biologic therapy change treatment paradigms. The pred dose in SLE was a close second.
  • Picking CD40L as it gives us hope that we will finally have a specific option for Sjogren’s even for patients without severe organ-threatening disease.
  • This tournament has been incredibly fun to be a part of. It has had twists and turns that has been fun to be involved with. My approach to innovation a) is it novel? B) is it an area of need? C) is it an innovative study design? D) was this an interesting selection by the submitting team? E) does it affect a large number of patients? F) is it practical, realistic, affordable and close to actuality? These two teams made it to the finals on the backs of meeting these innovative marks. While I differed from the overall committee on many selections, I commend them for their process. Both these studies take an approach to revolutionize care that affects broad numbers of patients in rheumatology and have had out of the box thinking. The winner though is clearly Cd40L in this round. It is an unmet need for care in Sjogrens and can impact lives of so many patients who have been told there are no good available options. The trial was innovative in tackling the subjective symptoms as well as the easier to follow objective data. They cut down the nets and have their “One Shining Moment” in RheumMadness 2025. Credit to silver medalist Prednisone dosage which challenges assumptions and addresses issues in common practice, but the meta-analysis of prior studies is not nearly as innovative as the new design for a new drug in Sjogrens.
  • One panelist did not leave comments (they must have thought the team spoke for itself!)

In contrast, the two panelists in favor of pred dose in SLE had this to say:

  • The Sjogren’s CD40L study is of a novel agent and shows benefit in Sicca symptoms but is not yet able to be applied. I can use the data from the Prednisone dose in SLE study tomorrow to inform patient care – that’s the winner for me.
  • The steroid dosing study in lupus nephritis delivered strong data to guide a question we face all the time in practice and having clear, evidence-based suggestions for such a common challenge is incredibly valuable. And the graphic was an absolute slam dunk! It was clear, engaging, fun, and by far the best from this year’s scouting event!

How did the participants do?

This year, we had 99 submissions from colleagues all over the world.  In fact, of the participants who had never played RheumMadness before, 34% were from a non-US nation.  We LOVE growing internationally, and it was so fun to connect with all of you throughout the game!

There were no perfect brackets, but some of you did incredibly well!  The winners in our three major categories are as follows:

Overall winner: ola_sou_iago

Each of the winners will be emailed so they can claim their prize.

You can see all of the top 10 brackets below.  Yes, David Leverenz finally did well in the tournament (fulfilling a lifelong dream), but he is disqualified from winning any category as the tournament organizer.

Rank Bracket Name Points
1 ola_sou_iago 19
2 WashURheumFellows 18
3 DavidLeverenz 17
4 ilereynosa 15
4 SpanRheum 15
4 mccuella@gmail.com 15
7 jacquelinumab 14
7 alhkim 14
7 eaw81 14
7 sjogrens sjooters 14

 

Time to say thank you

Now that RheumMadness 2025 is in the books, we have some major thank you-s to hand out.

First, thank you to our amazing scouting report authors.  The teams in RheumMadness 2025 were proposed by 67 collaborators (20 attendings, 35 fellows, 5 residents, 5 medical students, 2 “other”) from 21 different institutions around the world. Together, these amazing people wrote fun and informative scouting reports that drew attention to some of the latest and greatest innovations in rheumatology.  THANK YOU!

Second, thank you to our amazing Blue Ribbon Panel. While they made some controversial picks this year, I can assure you that they put a ton of thought and effort into making their decisions.  We create a panel full of different perspectives of voices for a reason, and that really shined this year.  Thank you so much for all of your time!

Third, thank you to our friends from theMednet.org, who created amazing practical Q&As to go along with each team in the tournament.  These Q&As helped our participants go deeper into each topic and discover how to apply the knowledge from RheumMadness into their practice today.  Thank you for all your time and collaboration!

Fourth, thank you to our incredible RheumMadness leadership team. These incredible people help organize the tournament, provide in-depth peer review of each scouting report and visual tool, contribute to the podcasts, and make amazing tools like our new fellowship toolkit.  We couldn’t do this without their contributions!

Last but certainly not least, thank you to our participants.  Thank you for subscribing to our newsletter, listening to the podcast, submitting a bracket, and interacting on social media.  RheumMadness has always been about learning together, and you all continue to bring your amazing craziness about rheumatology each and every year!

Don’t forget to subscribe to our podcast and newsletter so you can stay connected with future updates from RheumMadness.  You can also connect with us on social media in the following places:

  1. Follow us on Bluesky
  2. Follow us on Instagram
  3. Join the conversation on X, formerly known as Twitter using #RheumMadness.

Round 3 Results

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!)

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

  1. Follow us on Bluesky
  2. Follow us on Instagram
  3. Join the conversation on X, formerly known as Twitter using #RheumMadness.

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

Round 2 Results

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:

  1. Follow us on Bluesky
  2. Follow us on Instagram
  3. Join the conversation on X, formerly known as Twitter using #RheumMadness.

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

Round 1 Results

The first round of RheumMadness 2025 had three blowouts and one MASSIVE upset. 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.

What’s next? Tomorrow, we will release a new podcast episode with our leadership team’s reaction to the first round results.  Results from additional rounds will be released as follows:

  • Round 2 (the Entheseal Eight): April 3
  • Round 3 (the IgG Four): April 5
  • Round 4 (the Interleukin Two): April 7

First Matchup: CD40L in Sjogren’s defeats APIPPRA

The Blue Ribbon Panel unanimously chose CD40L in Sjogren’s over APIPPRA in a 7-0 blowout.  Hear their justification below:

  • What could be more “innovation”-like than a medication where there is an unmet need? While prevention is better in the long term, from a purely immediate, practical standpoint, the urgency to help those already ill might be considered as higher priority than intercepting something that isn’t there yet – and already has many options in case it does manifest.
  • I find the use of CD40L for Sjogren’s to be more innovative and fulfilling a greater need than the ABA for Pre-RA. The response to the ABA was too small and likely not worth the expense. I also noted that the study was drug funded. This should not make a difference but of course it does.
  • I chose CD40L in Sjogren’s based on the quality of the report and visual aid and the desperate need for any therapies that provide relief to Sjogren’s patients. The article for the abatacept in pre-RA is great, but the visual aid is not nearly as informative as its competitor AND I do not see any insurers paying for abatacept for RA prevention any time soon, so clinical applicability of the chosen article is also not clear.
  • SS is underrepresented in clinical research and drug discovery, the inclusion of the high symptom burden participant group, and trial of new class of therapeutic based on underpinning immune pathways that lead to escape of immune tolerance.
  • APPIPRA study not a novel as also the ARRIA study in same issue of the Lancet – both could have been included in scouting report?
  • Great matchup of two innovative concepts. Pre-RA prevention is incredibly exciting and the idea of stopping RA that sustains after discontinuation is incredibly novel… however, CD40L wins for two major reasons. 1) There is no approved targeted therapies for Sjogren’s  2) They included symptom burden in the analysis. Despite only early research, the idea of finding mechanisms to help the symptom burden in Sjogren’s pushes out the round 1 win.
  • 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 need in treatment. The visual representation was particularly creative, with the Sjögren’s horse wordplay adding a clever touch that made the study more engaging. Additionally, the flowchart outlining treatment groups, interventions, and outcomes was clear and easy to follow, effectively guiding the reader through the study’s design. The infographic and scouting report introduced an innovative option in Sjögren’s treatment with clarity and accessibility.
  • Novel targeted and effective therapy in Sjogren’s disease would be a game changer for these patients across the board, especially considering the dearth of effective agents for patients with Sjogren’s disease. While both are great trials, considering the number of options we have for RA therapy vs the lack of options for management of Sjogren’s disease at this time, I went with CD40L in Sjogren’s disease.

Second Matchup: TYK2 in SLE defeats long-term anifrolumab

The Blue Ribbon Panel unanimously chose TYK2 in SLE over long-term anifrolumab in another 7-0 blowout.  Hear their justification below:

  • Sticking with the “innovation” theme – while Anifrolumab is new, it is already in many guidelines. Deucravacitinib offers an “innovation” approach because it is in oral form. If you are paying out of pocket, an oral medication helps you avoid needing to go to the hospital for infusion schedules, which is an additional cost, loss of time and needing to leave work.
  • I find the fact that TYK2 works and is oral to be innovative. It is also an interferon blocker similar to anifrolumab.  I wonder if there will be studies in the future comparing the use of anifrolumab and TYK2 inhibitors.
  • TYK2 in SLE is the winner here for me due to the quality of the visual aid, all the basketball puns in the report, and the novelty of TYK2 inhibitors in SLE (thus, being a more innovative option than tried and true Saphnelo).
  • TYK2 is new class of ORAL treatment for SLE and showed improvements over placebo in all outcome measures over almost a year, with GREAT AE profile (not many!) This definitely beats a LTE, with risk of bias
  • With lots of recent innovation in SLE, it is great to have this match-up of good therapies. With JAK inhibitors disappointing in lupus, the TYK2 data is exciting in its broad efficacy and safety.
  • Both studies were important and engaging, but the TYK2 inhibitor stood out as an intriguing potential treatment, particularly because it is an oral medication with a novel mechanism of action for lupus treatment. The study’s graphic was clear and effectively conveyed key points, making it easy to follow. The report itself was engaging, almost reading like an advertisement, drawing in our attention and making the findings feel exciting. The creative puns and basketball references added a fun and memorable touch, making the presentation even more memorable.
  • Since Anifrolumab already had strong data in it’s favor, the concept of an oral agent like Deucravacitinib being clinically efficacious against multiple end points is a promising novel avenue to explore!

Third Matchup: Pred dose in SLE defeats HCQ screen cost

The Blue Ribbon Panel chose pred dose in SLE over HCQ screen cost 5-2.

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

  • It is true the HCQ screening is often either too much or too little. I wonder since we can now order HCQ blood levels if screening will not be as much of an issue. Verifying that we can safely get by with lower doses of corticosteroids to me is more important.
  • Steroid dose wins hands down. The visual aid is absolutely amazing and the topic is SO important now and will only continue being more relevant in the future. Great job! Reduced screening in HCQ seems difficult to achieve in clinical practice (as people might forget to get their exam) and unlikely to get significant patient buy-in (patients are SO worried about retinopathy and mostly already see an eye doctor yearly). I appreciate the puns in the report, however.
  • Pred dose paper gives valuable data to undertake shared decision making with patients in the trade off of better chance of good renal outcomes versus increased risk of infection and 10 fold incr risk of death. And highlights the unmet need in lupus nephritis. I am also not sure how generalisable the HCQ screen data are to other health care settings
  • Compared to the hydroxychloroquine study, the steroid dosing study in lupus nephritis provided a stronger level of evidence as a systematic review, addressing a crucial and frequently debated question in rheumatology: the optimal steroid dose for both efficacy and safety. This is a topic we constantly encounter in clinical practice, making the study particularly relevant. The graphic was exceptionally well-designed and professional, effectively distilling the key findings into a format that was both engaging and informative. It presented the suggested dosing in a way that was clear at a glance, making it easy to remember and apply in real-world scenarios. The creative and fun approach to the infographic further enhanced its impact.
  • Both are great trials, but in depth understanding of the impact of our glucocorticoid practices forges the path towards developing newer and effective steroid sparing therapies for life threatening rheumatologic conditions like lupus nephritis.

In contrast, the panelists who chose HCQ screen cost had this to say:

  • The “innovation” aspect here is an invitation to rethink and improve current screening guidelines to be more.. optimal? more efficient and resource-conscious while maintaining patient safety. The prednisone study, while also relevant, is only refining what we already do rather than optimizing. I think the infographic was one of the best though.
  • Innovative study and an innovative choice by the Lankenau Internal Medicine team. Innovation is not necessarily a novel, unique therapy, but challenging our assumptions and affecting the lives of wide swaths of rheumatology patients worldwide. This is a great approach to finding ways to innovative our day-to-day practice and optimize patient care.

Fourth Matchup: Obinutuzumab in lupus nephritis defeats CD-19 CAR-T

Ah, now the madness truly begins. This was a massive upset. The Blue Ribbon Panel chose obinutuzumab in lupus nephritis over CD19 CAR-T Cells in a 4-3 nail-biter.

Here’s what those in favor of obinutuzumab in lupus nephritis had to say:

  • This was difficult because both fit the theme for “innovation”. However, i feel that Obinutuzumab is the Queen here. It can be readily integrated to current Rheumatology practice. CAR-T has problems of scalability, wide-spread application and long-term global feasibility. Access can also be difficult – You need specialized centers and infrastructure, you need doctors who have the training and proper funding.
  • I know that CAR T cell therapy is very impressive but I find the expense and risk to be too great. It will only help a small number of people. Obinutuzumab is a novel way of blocking B cells and most likely has the potential to help a larger number of people.
  • Great to have a novel therapy that has potential to enhance outcomes in lupus nephritis, where there is so much unmet need. Beside CAR T paper is still just a small case series……
  • CD19 CAR T definitely created a paradigm shift in options for refractory and severe rheumatologic disease. However till we gather substantial data, we are favoring Obinutuzumab in terms of agents with strong evidence for current and practical utility in lupus nephritis.

In contrast, here’s what those in favor of CD19 CAR-T Cell Therapy had to say:

  • As much as it pains me to have to pick CAR-T cells again, I think CD-19 CAR-T is the winner here. It is a ground-breaking therapy that has the promise of curing autoimmune disease. Additional points to the team for using AI to help with the visual aid! If Obinutuzumab was compared to, say, belimumab + MMF + prednisone, it would have been an awesome very clinically applicable trial. However, just on its own, it is not quite as innovative or promising as CAR-T cells. Kudos to the Obinutuzumab team for making a clearly readable visual aid that is  not too busy.
  • CAR-T has garnered a lot of attention in the rheumatology field with only small trials and limited follow-up but has the clear potential to revolutionize our field with possibility of curing our most severe patients.
  • The CAR-T therapy study perfectly aligned with the purpose of this scouting event as an innovative and forward-thinking study. While it was a small-sized case series, it offers hope for both providers and patients, hinting at a potential breakthrough that could revolutionize rheumatology. The scouting report itself was engaging and fun to read, making complex science feel exciting and accessible. We counted over 20 sports references, which added more creativity to the writing.

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

  1. Follow us on Bluesky
  2. Follow us on Instagram
  3. Join the conversation on X, formerly known as Twitter using #RheumMadness.

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

Brackets Are Open!

Welcome to RheumMadness – the place for everyone who is crazy about rheumatology to connect, collaborate, compete, and learn together. RheumMadness is a FREE educational tournament for everyone who is crazy about rheumatology. First time playing? Head over to our RheumMadness 101 page to learn more.

The theme for RheumMadness 2025 is “The Innovation Invitational.” Each of the 12 teams in this year’s tournament is based on a recent article published in the last 2 years vying to be named “the most important article for patients, providers, and/or researchers, both now and in the future.”  The teams were proposed by 67 collaborators (20 attendings, 35 fellows, 5 residents, 5 medical students, 2 “other”) from 21 different institutions around the world. Together, these amazing people have written fun and informative scouting reports that will draw attention to some of the latest and greatest innovations in rheumatology, and we can’t wait to share them with you.

How to Play RheumMadness

  1. Read the scouting reports and listen to the RheumMadness podcast to learn about the teams in the tournament.
  2. Submit your picks before April 1, 2025.
  3. Enjoy the tournament! The tournament results will be released in 4 rounds from April 1-7, 2025.

How are matches determined?

We are thrilled to introduce the Blue Ribbon Panel for RheumMadness 2025: The Innovation Invitational.  This panel of distinguished rheumatologists will vote to determine which teams advance in the tournament.  The more your predictions match those of the panel, the more points you will get in the tournament!  Learn more about our panelists below.

Attending panel members:

  • Anastasiya (Stacy) Bagrova, MD completed internal medicine residency at Duke, rheumatology fellowship at the University of South Florida, and is now a practicing rheumatologist in Clearwater, FL. Similar to her clinical practice, her clinical interests in rheumatology are broad.  Follow her on X at @asbagrova.
  • Eric Dein, MD, is currently living in Jersey City, NJ – hometown of the March Madness great Cinderella St Peter’s Peacock team. He is currently practicing rheumatology at Atlantic Health System at Overlook Hospital in Summit and West Orange, NJ, after completing medical school, residency and fellowship at Johns Hopkins. He is a USSONAR alumnus who utilizes musculoskeletal ultrasound in diagnosis and management of rheumatic disease. He is currently serving as ACR committee member on the Annual Meeting Planning Committee and enjoys advocacy trips to DC with Advocates for Arthritis. He has been a reporter for RheumNow at rheumatology conferences for the past 5 years. Follow him on X at @ericdeinmd.
  • Rebecca Grainger, MB ChB (Dstn), PhD, FRACP, is Professor of Medicine at the University of Otago, Wellington, New Zealand. A University of Otago medical graduate, she undertook rheumatology training in Melbourne and her PhD examined inflammatory mechanisms in gout. Dr. Grainger’s clinical work focuses on assessment and management of inflammatory arthritis and her particular clinical interests include inflammatory arthritis, gout, and scleroderma. Dr. Grainger’s academic interests are wide but she aims to undertake research in clinical rheumatology, health professions education and technology.  Follow her on X @Drbeckyg and on Bluesky at @profbeckyg.bsky.social.
  • Lakshmi Jayaram, MD, is a clinician educator and Assistant Professor in the Division of Immunology and Rheumatology at Stanford University. Her academic interests are mainly in medical education, quality improvement, patient safety and social determinants of health. As a clinician, she is a general rheumatologist with special interests in myositis, gout, psoriatic arthritis, and vasculitis.
  • Michele Meltzer, MD, MBE, is an Associate Professor of Medicine at Thomas Jefferson University in Philadelphia, Pennsylvania. She attended Hahnemann Medical School and rheumatology fellowship at Temple University Hospital. In 2007, she completed a Master’s of Bioethics at the University of Pennsylvania. Dr. Meltzer has been a ACR committee member of Rheumatologic Care and Ethics and Conflict of Interest committees. She serves as President and founding member of Rheumatology for All, a nonprofit whose mission is to increase access to rheumatology care in resource limited areas. She loves that RheumMadness makes learning about rheumatology fun and is accessible to students worldwide. Follow her at @mmeltz.bsky.social.
  • Lisa Traboco, MD, is a rheumatologist with a passion for digital health, social media, telemedicine, and medical education. She likes to integrate technology into clinical practice and training, as well as participate in systems implementation. She is currently pursuing a Master’s in Health Informatics while working at St. Luke’s Medical Center – Global City in the Philippines. She is also actively involved in APLAR & has been an exchange scholar to Japan and the ACR. Her interests include learning languages, watching K-dramas & visiting historical museums. Follow her on X at @rheumarhyme and Bluesky at @rheumarhyme.bsky.social.

Fellow panel members:

This year, two fellows from the University of South Florida will work together to submit one collective vote for each matchup.

  • Noor Bazerbashi, MD, is a second-year rheumatology fellow at the University of South Florida. She has a strong interest in interstitial lung disease and the applications of cellular therapy in rheumatic diseases.
  • Molly Leavitt, MD, MBA, is a first-year rheumatology fellow at the University of South Florida. Her interests include medical education and reproductive health for patients with rheumatic diseases.

What do I get if I win?

Participants with the most correct predictions will “win” RheumMadness. Prizes will be given to participants with the top scores in the following categories: (1) Attending / APP, (2) Fellow, and (3) Resident / Medical Student. The prize is a custom RheumMadness coffee mug and a lifetime of bragging rights. But really, everyone wins in RheumMadness because you get to connect, collaborate, compete, and learn together.

Other ways to connect with RheumMadness

  1. Subscribe to the RheumMadness newsletter.
  2. Listen to the RheumMadness podcast, available on all major podcasting apps.
  3. Follow us on Bluesky!
  4. Follow us on Instagram!
  5. Join the conversation on X, formerly known as Twitter using #RheumMadness.
  6. Explore even more content on the RheumMadness website

RheumMadness on theMednet.org!

The RheumMadness team is excited to announce continued collaboration with theMednet.org for the 2025 tournament.  theMednet is a physician only site providing a space for physicians to tackle difficult clinical questions and see how colleagues are practicing. theMednet will be featuring select Q&A relevant to articles in our 2025 tournament and will provide a space for further discussion and polling around clinical application. Register here for a free account with full access to the site and RheumMadness content!

New fellowship toolkit!

RheumMadness participants consistently report a positive learning experience and increased connection to the rheumatology community. We learned that some fellowship programs have integrated RheumMadness in a variety of ways to boost connection within their own program and beyond.  To help more fellowship programs accomplish this, we’ve created a new fellowship toolkit with suggestions on incorporating RheumMadness into a fellowship journal club and other learning activities.

 

2025 Blue Ribbon Panel

We are thrilled to introduce the Blue Ribbon Panel for RheumMadness 2025: The Innovation Invitational.  This panel of distinguished rheumatologists will vote to determine which teams advance in the tournament.  The more your predictions match those of the panel, the more points you will get in the tournament!  Learn more about our panelists below.

Attending panel members:

  • Anastasiya (Stacy) Bagrova, MD completed internal medicine residency at Duke, rheumatology fellowship at the University of South Florida, and is now a practicing rheumatologist in Clearwater, FL. Similar to her clinical practice, her clinical interests in rheumatology are broad.  Follow her on X at @asbagrova.
  • Eric Dein, MD, is currently living in Jersey City, NJ – hometown of the March Madness great Cinderella St Peter’s Peacock team. He is currently practicing rheumatology at Atlantic Health System at Overlook Hospital in Summit and West Orange, NJ, after completing medical school, residency and fellowship at Johns Hopkins. He is a USSONAR alumnus who utilizes musculoskeletal ultrasound in diagnosis and management of rheumatic disease. He is currently serving as ACR committee member on the Annual Meeting Planning Committee and enjoys advocacy trips to DC with Advocates for Arthritis. He has been a reporter for RheumNow at rheumatology conferences for the past 5 years. Follow him on X at @ericdeinmd.
  • Rebecca Grainger, MB ChB (Dstn), PhD, FRACP, is Professor of Medicine at the University of Otago, Wellington, New Zealand. A University of Otago medical graduate, she undertook rheumatology training in Melbourne and her PhD examined inflammatory mechanisms in gout. Dr. Grainger’s clinical work focuses on assessment and management of inflammatory arthritis and her particular clinical interests include inflammatory arthritis, gout, and scleroderma. Dr. Grainger’s academic interests are wide but she aims to undertake research in clinical rheumatology, health professions education and technology.  Follow her on X @Drbeckyg and on Bluesky at @profbeckyg.bsky.social.
  • Lakshmi Jayaram, MD, is a clinician educator and Assistant Professor in the Division of Immunology and Rheumatology at Stanford University. Her academic interests are mainly in medical education, quality improvement, patient safety and social determinants of health. As a clinician, she is a general rheumatologist with special interests in myositis, gout, psoriatic arthritis, and vasculitis.
  • Michele Meltzer, MD, MBE, is an Associate Professor of Medicine at Thomas Jefferson University in Philadelphia, Pennsylvania. She attended Hahnemann Medical School and rheumatology fellowship at Temple University Hospital. In 2007, she completed a Master’s of Bioethics at the University of Pennsylvania. Dr. Meltzer has been a ACR committee member of Rheumatologic Care and Ethics and Conflict of Interest committees. She serves as President and founding member of Rheumatology for All, a nonprofit whose mission is to increase access to rheumatology care in resource limited areas. She loves that RheumMadness makes learning about rheumatology fun and is accessible to students worldwide. Follow her at @mmeltz.bsky.social.
  • Lisa Traboco, MD, is a rheumatologist with a passion for digital health, social media, telemedicine, and medical education. She likes to integrate technology into clinical practice and training, as well as participate in systems implementation. She is currently pursuing a Master’s in Health Informatics while working at St. Luke’s Medical Center – Global City in the Philippines. She is also actively involved in APLAR & has been an exchange scholar to Japan and the ACR. Her interests include learning languages, watching K-dramas & visiting historical museums. Follow her on X at @rheumarhyme and Bluesky at @rheumarhyme.bsky.social.

Fellow panel members:

This year, two fellows from the University of South Florida will work together to submit one collective vote for each matchup.

  • Noor Bazerbashi, MD, is a second-year rheumatology fellow at the University of South Florida. She has a strong interest in interstitial lung disease and the applications of cellular therapy in rheumatic diseases.
  • Molly Leavitt, MD, MBA, is a first-year rheumatology fellow at the University of South Florida. Her interests include medical education and reproductive health for patients with rheumatic diseases.

RheumMadness 2025 is Here!

Welcome to RheumMadness – the place for everyone who is crazy about rheumatology to connect, collaborate, compete, and learn together. RheumMadness is a FREE educational tournament for everyone who is crazy about rheumatology. First time playing? Head over to our RheumMadness 101 page to learn more.

RheumMadness 2025: The Innovation Invitational

The theme for RheumMadness 2025 is “The Innovation Invitational.” Each of the 12 teams in this year’s tournament is based on a recent article published in the last 2 years vying to be named “the most important article for patients, providers, and/or researchers, both now and in the future.”  The teams were proposed by 67 collaborators (20 attendings, 35 fellows, 5 residents, 5 medical students, 2 “other”) from 21 different institutions around the world. Together, these amazing people have written fun and informative scouting reports that will draw attention to some of the latest and greatest innovations in rheumatology, and we can’t wait to share them with you. Bracket submissions begin in March, and the tournament will begin April 1, 2025.

***NEW IN 2025***

This year, we are releasing the scouting reports slowly over several months to give everyone more time to learn about the topics before the tournament.

Each scouting report release will be accompanied by weekly podcast episodes with more detailed analysis, interviews of scouting report authors, discussion of Q&As from theMednet.org related to RheumMadness content, and more!

Links to each scouting report (or anticipated release dates) are below.

Region 1: T’d Up T Cells

Region 2: Cytokine Crushers

Region 3: Full-Court Care Champions

Region 4: B-Cell Breakaway

RheumMadness on theMednet.org!

The RheumMadness team is excited to announce continued collaboration with theMednet.org for the 2025 tournament.  theMednet is a physician only site providing a space for physicians to tackle difficult clinical questions and see how colleagues are practicing. theMednet will be featuring select Q&A relevant to articles in our 2025 tournament and will provide a space for further discussion and polling around clinical application. Register here for a free account with full access to the site and RheumMadness content!

 

New fellowship toolkit!

RheumMadness participants consistently report a positive learning experience and increased connection to the rheumatology community. We learned that some fellowship programs have integrated RheumMadness in a variety of ways to boost connection within their own program and beyond.  To help more fellowship programs accomplish this, we’ve created a new fellowship toolkit with suggestions on incorporating RheumMadness into a fellowship journal club and other learning activities.

 

Other ways to connect with RheumMadness

  1. Subscribe to the RheumMadness newsletter.
  2. Listen to the RheumMadness podcast, available on all major podcasting apps.
  3. Follow us on Bluesky!
  4. Follow us on Instagram!
  5. Join the conversation on X, formerly known as Twitter using #RheumMadness.

 

CD-19 CAR T-Cells

Team: B-Cell Busters

Base article: Müller F, Taubmann J, Bucci L, Wilhelm A, Bergmann C, Völkl S, Aigner M, Rothe T, Minopoulou I, Tur C, Knitza J, Kharboutli S, Kretschmann S, Vasova I, Spoerl S, Reimann H, Munoz L, Gerlach RG, Schäfer S, Grieshaber-Bouyer R, Korganow AS, Farge-Bancel D, Mougiakakos D, Bozec A, Winkler T, Krönke G, Mackensen A, Schett G. CD19 CAR T-Cell Therapy in Autoimmune Disease – A Case Series with Follow-up. N Engl J Med. 2024 Feb 22;390(8):687-700. doi: 10.1056/NEJMoa2308917. PMID: 38381673.

Authors: Vanderbilt Rheumatology Fellowship Program

  1. Yash Pershad, medical student, Vanderbilt University School of Medicine
  2. Genessis Maldonado, MD, Fellow, Division of Rheumatology and Immunology, Vanderbilt University Medical Center
  3. Tyler Reese, MD, Assistant Professor of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center

Team Overview: 

CAR T-cells just pulled off the biggest cross-division upset in rheumatology history. After revolutionizing the oncology league, these engineered cellular superstars crossed over to autoimmunity with style.

In this groundbreaking series, 15 players with refractory autoimmune disease (8 SLE, 3 myositis, 4 systemic sclerosis) who had struck out with conventional therapies got drafted into the CAR T-cell program. The results? Nothing but net—every single patient broke free from immunosuppressive drugs and scored long-term remission with manageable side effects.

What makes this squad special isn’t just their full-court press targeting B cells. Unlike other B-cell depleting veterans like rituximab, these CD19 CAR T-cells take down both B cells and plasmablasts. These T-cells have hustle and heart—they dive straight into the tissues and eliminate targets without waiting for backup from other immune system teammates. By deploying this deep bench of CD19-targeted CAR T-cells, they don’t just temporarily put autoimmune B cells in the penalty box like rituximab—they completely retool the immune roster, potentially leading to long-term tolerance. Their defensive IQ is off the charts—they preserve those crucial vaccine-memory plasma cells while eliminating the troublemakers. That’s the kind of smart, selective defense that wins championships.

The study evaluated the efficacy and safety of this game-changing therapy using disease-specific assessment tools. For systemic lupus erythematosus (SLE), disease activity was measured using the SLEDAI-2K score. Idiopathic inflammatory myositis (IIM) was assessed through serum creatine kinase levels, the Manual Muscle Test-8 (MMT-8), and the ACR-EULAR Total Improvement Score. In systemic sclerosis (SSc), disease severity was monitored using the modified Rodnan skin score (mRSS). Secondary endpoints included tracking the duration of clinical remission, persistence of CAR T cells, and incidence of adverse events, ensuring a comprehensive evaluation of the therapy’s long-term impact.

Admittedly, it is still early in the season with only 15 players on the roster—some may call this a fluke from a small-market team. But the implications for future patients are undeniably championship-caliber. CAR T-cell therapy represents a paradigm shift with the potential to revolutionize how we manage autoimmune disease.

Related content on theMednet.org:

How do you envision incorporating CAR-T therapy into your clinical practice?

Back to the full list of scouting reports

Obinutuzumab in Lupus Nephritis

Team: Obinutuzumab’s Got Game 

Base article: Furie RA, Aroca G, Cascino MD, Garg JP, Rovin BH, Alvarez A, Fragoso-Loyo H, Zuta-Santillan E, Schindler T, Brunetta P, Looney CM, Hassan I, Malvar A. B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2022 Jan;81(1):100-107. doi: 10.1136/annrheumdis-2021-220920. Epub 2021 Oct 6. PMID: 34615636; PMCID: PMC8762029.

***NOTE: This team was originally based on the phase II study results.  In February of 2025, the phase III results of the REGENCY trial was published in the New England Journal of Medicine (click for link).

Authors: University of Michigan Fellowship Program

  1. Annie Carlton, MD, PhD, rheumatology fellow, University of Michigan
  2. Rocio Bautista Sanchez, MD, rheumatology fellow, University of Michigan
  3. Rishika Chin, MBBS, rheumatology fellow, University of Michigan
  4. Lauren He, MD, rheumatology fellow, University of Michigan
  5. Arati Kelekar, MBBS, rheumatology fellow, University of Michigan
  6. Marianne Kerski, MD, rheumatology fellow, University of Michigan
  7. Yasmin Khader, MD, rheumatology fellow, University of Michigan
  8. David Riccardi, MD, rheumatology fellow, University of Michigan

Team Overview: 

Picture this: a 30-year-old female patient with systemic lupus erythematosus (SLE) and lupus nephritis (LN) on hydroxychloroquine, mycophenolate, and a stubborn prednisone requirement with persistent proteinuria despite your best efforts. What do you do next?

Obinutuzumab is an anti-CD20 monoclonal antibody with greater antibody-dependent cellular toxicity than traditional B cell depleting agents. In this double-blinded, placebo-controlled trial, adults with SLE and class III or IV LN with proteinuria (UPCR >1, eGFR≥30) who were treated with obinutuzumab were more likely to achieve complete renal response defined by UPCR<0.5, normal Cr (within 15% of baseline), and inactive sediment. Importantly, the greatest benefit was seen in those with baseline UPC>3 and class IV LN. Secondary outcomes were also impressive with greater improvement in eGFR, less rescue therapies, and rapid sustained depletion of CD19 cells in the obinutuzumab group. There were similar numbers of adverse events in both groups.

For a disease that has been described as far back as the 13th century, there has been a stagnant arsenal of medications in the rheumatologist’s toolbox for decades. Obinutuzumab reflects an exciting movement in SLE research today to expand therapeutic targets. This trial specifically includes patients we are most concerned about – those with marked kidney disease. While CAR-T is an innovative topic, it is not something that you pull from your bench to tag in when the game is on the line today. For that reason, we think the NOBILITY trial with obinutuzumab is the most important article for patients and providers.

***NOTE: The team overview above refers to the phase II study results.  In February of 2025, the phase III results of the REGENCY trial was published in the New England Journal of Medicine (click for link).

Related content on theMednet.org:

In the treatment of lupus nephritis, which patients may benefit from the use of rituximab or other B-cell depleting agents during induction?

What are the potential barriers to the widespread use of obinutuzumab in proliferative lupus nephritis?

Back to the full list of scouting reports

STRAP Trial

Team: RheumaNavigators

Base article:  Rivellese F, Nerviani A, Giorli G, Warren L, Jaworska E, Bombardieri M, Lewis MJ, Humby F, Pratt AG, Filer A, Gendi N, Cauli A, Choy E, McInnes I, Durez P, Edwards CJ, Buch MH, Gremese E, Taylor PC, Ng N, Cañete JD, Raizada S, McKay ND, Jadon D, Sainaghi PP, Stratton R, Ehrenstein MR, Ho P, Pereira JP, Dasgupta B, Gorman C, Galloway J, Chinoy H, van der Heijde D, Sasieni P, Barton A, Pitzalis C; STRAP collaborative group. Stratification of biological therapies by pathobiology in biologic-naive patients with rheumatoid arthritis (STRAP and STRAP-EU): two parallel, open-label, biopsy-driven, randomised trials. Lancet Rheumatol. 2023 Nov;5(11):e648-e659. doi: 10.1016/S2665-9913(23)00241-2. PMID: 38251532.

Authors: EMEUNET

 

  1. Yvonne Tan, BSc, MD, MSc, Clinical Research Fellow, University of Manchester, United Kingdom, Clinical research fellow
  2. Jean-Guillaume Letarouilly, MD, PhD, Service de rhumatologie, CHU Lille, Univ. Lille, Lille, France, Attending
  3. Guillermo Carvajal Alegria, MD, PhD, Department of Rheumatology, Tours University Hospital, Tours University, Tours, France, Associate Professor
  4. Milena Bond, Department of Rheumatology, Teaching Hospital of the Paracelsus Medical University, Hospital of Bruneck  (ASAAA-SABES), Bruneck, Italy, PhD candidate.
  5. Francesca Crisafulli, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili  of Brescia, University of Brescia, Brescia, Italy, Attending
  6. Magda Osipyan, Department of Rheumatology, Vardanants Medical Center, Yeveran, Armenia, Associate Professor
  7. Alejandro Gomez Gomez, MD, PhD, Department of Rheumatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain, Attending
  8. Krystel Aouad, MD, MSc, MPH, Department of Rheumatology, Saint George Hospital University Medical Center, Saint George University of Beirut, Lebanon, Assistant Professor

Team Overview: 

The STRAP trial is like setting sail with a “golden compass” to navigate the uncharted waters of rheumatoid arthritis (RA) treatment, with personalized medicine as the ultimate destination. A total of 223 RA patients across 26 centres in the UK and Europe embarked on this quest, none having previously used biological therapies. Each patient underwent a “mystical” synovial biopsy to reveal their B cell type—either “B cell-poor” or “B cell-rich”—intended to serve as a guiding light.

Three biological “armors”—rituximab, etanercept, and tocilizumab—were chosen as companions, each patient randomly assigned to one. The hope? That this “golden compass” of B cell types would direct researchers to the ideal treatment for each patient. However, the journey proved more complex than anticipated. After 16 weeks, the B cell profiles did not reveal the anticipated answers. Rituximab was not the “guiding star” as there was no difference in ACR 20 response (primary endpoint) compared with the other two “armors”: tocilizumab or etanercept. Yet, the “golden compass” provided valuable information as there was a lower response to rituximab in patients with a “pauci-immune” (low immune cell) profile, and B cell-rich patients treated with rituximab faced an increased risk of joint damage.

Yet, there was a silver lining: all three treatments held steady in terms of safety, acting like steadfast allies in Lyra’s world and protecting patients equally well across B cell profiles. Although the STRAP trial did not provide a definitive answer, it became a compass pointing researchers toward deeper questions in RA treatment. The journey to precision medicine continues, with the “golden compass” guiding the way through RA’s vast, uncharted landscape and setting the course for future discovery. The compass is set, and the adventure awaits.

Related content on theMednet.org:

Does synovial biopsy provide diagnostic value in undifferentiated inflammatory arthritis?

Back to the full list of scouting reports