Hydroxychloroquine Dose in Lupus Remission

 Prolonged remission was observed in 72% of patients with systemic lupus erythematosus (SLE) who were treated with a consistent 200 mg daily dose of hydroxychloroquine.

METHODOLOGY:

• Researchers conducted an observational study using data from the Lupus-Cruces cohort to evaluate the daily and weight-adjusted dosages of hydroxychloroquine and their effects on long-term remission in patients with SLE.
• The study included 150 patients with SLE (mean age at diagnosis, 41 years; 80.7% women) who were followed for at least 5 years. Patients were excluded if they did not receive hydroxychloroquine or died before 5 years of follow-up.
• The primary outcome was remission, assessed annually using the definitions of remission in SLE (DORIS) criteria. Prolonged remission, defined as meeting DORIS criteria for five consecutive years, was also evaluated.
• Analyses were stratified by baseline SLE Disease Activity Index scores, classified as mild, moderate, or severe, and by diagnosis year, grouped into four periods: 2001-2005, 2006-2010, 2011-2015, and 2016-2018.
• Furthermore, associations between hydroxychloroquine doses and prednisone doses, immunosuppressive use, and mepacrine use were explored.

TAKEAWAY:

• The mean weight-adjusted hydroxychloroquine dose was 3.1 mg/kg/day at treatment initiation and 2.9 mg/kg/day during follow-up, with 99% of patients receiving < 5 mg/kg/day. The doses were comparable across subgroups stratified by year and disease activity.
• Prolonged remission occurred in 72% of patients, and initial weight-adjusted hydroxychloroquine doses did not significantly differ between those who achieved remission at 1 year and those who did not or between those who achieved prolonged remission and those who did not.
• Mean prednisone doses did not significantly differ by weight-adjusted hydroxychloroquine dosage at the 1-year or 5-year follow-up. Similarly, mean weight-adjusted doses of hydroxychloroquine remained unchanged in patients regardless of immunosuppressive or mepacrine treatment.
• Hydroxychloroquine treatment was maintained in 98% of patients over 5 years, with a mean duration of 58 months per patient.

IN PRACTICE:

"With the use of HCQ [hydroxychloroquine] at stable doses of 200 mg/day (or 3.0-3.5 mg/kg/day) as the background therapy, more than 70% of inception patients with SLE in our cohort achieved prolonged remission," the authors concluded.

SOURCE:

The study was led by Guillermo Ruiz-Irastorza, Biobizkaia Health Research Institute, Barakaldo, Spain. It was published online on February 26, 2025, in Lupus Science & Medicine.

LIMITATIONS:

The study could not compare the clinical course of patients receiving hydroxychloroquine doses lower and higher than 200 mg/day (or 5 mg/kg/day). Additionally, the study primarily included White participants and those with obesity, possibly limiting the generalisability of the findings to more diverse populations, including Black patients who may experience more severe forms of the disease.

DISCLOSURES:

One author reported receiving support from the Department of Education of the Basque Government. No relevant conflicts of interest were disclosed by the authors.

https://www.medscape.com/viewarticle/hydroxychloroquine-dose-sle-remission-2025a100050x

'US tariffs on Canada and Mexico will go ahead on Tuesday, says commerce chief: BBC'

US tariffs against Canada and Mexico will go ahead on Tuesday but their level will be decided by Donald Trump, the US commerce secretary has said.


The US president has threatened to impose 25% tariffs - which are a tax on imports - on his two neighbours on 4 March, in response to what he says is an unacceptable flow of illegal drugs and migrants into the US.

US Commerce Secretary Howard Lutnick said on Sunday the tariffs would happen as planned but the exact details will depend on negotiations.

A 10% tariff on Chinese imports is also expected to be implemented in response to US accusations that Beijing is not doing enough to stop the flow of fentanyl into the US.

This means that if brought into effect, Chinese exports to the US will face a levy of at least 20%, following a 10% tariff that took effect a month ago.


Chinese state media claims leaders in Beijing have prepared a series of countermeasures to happen on the same day, raising the prospect of an all-out trade war between the world's top two economies.

China's state-run Global Times newspaper said the countermeasures would probably target US agricultural and food products.

Analysts believe Beijing still hopes to avoid an all-out trade war and negotiate a truce with the Trump administration, but so far there has been no sign of a deal between the two economic giants.

Trump has long maintained that tariffs are a useful tool to correct trade imbalances and protect US manufacturing.

Speaking on Sunday Morning Futures on Fox News, Lutnick said: "There are going to be tariffs on Tuesday on Mexico and Canada. Exactly what they are, we're going to leave that for the president and his team to negotiate."


Canada has repeatedly said tariffs will harm both economies but added that it will defend itself if they happen.

Canadian Internal Trade Minister Anita Anand met officials in Washington in recent days and said over the weekend there will be a response.

"We are steady at the wheel. We are prepared for any eventuality, but we will at every turn defend our country's economy," she told CBC News.

Last month, Canada had prepared a list of $30bn (£23.6bn) worth of American goods it said it would levy in response to US tariffs. Items on that list included everyday goods like pasta, clothing and perfume.

The Canada Border Services Agency (CBSA) says it has been "surging" its efforts to tackle fentanyl crossing into the US.


Only 1% of fentanyl seized in the US is thought to come from Canada, according to US data.

Canadian Prime Minister Justin Trudeau said on Sunday, from a summit on Ukraine in London, that Canada was "not an issue" as a source of illegal fentanyl in the US.

Mexico's president, Claudia Sheinbaum, appeared to send a message to Trump after the Lutnick interview when she said at a public event in the city of Colima that "Mexico has to be respected".


"Co-operation [and] co-ordination, yes, subordination, never."

President Trump has also announced a 25% charge on all steel and aluminium imports, which is meant to come into effect on 12 March.

In addition, he has threatened to impose custom "reciprocal" tariffs on individual countries, as well as 25% tariffs on the European Union.

https://www.bbc.com/news/articles/cn48q3150dxo

Oil Prices Plunge As OPEC+ 'Delegate' Hints At Output Hikes 'Due To Trump Pressure'

 Bloomberg is reporting, according to a 'delegate' that OPEC+ will proceed with plans to revive halted oil production after repeated delays, amid pressure from President Donald Trump to lower oil prices.

The surprise move - which immediately sent crude prices reeling - means the group led by Saudi Arabia and Russia will go ahead with the increase of 138,000 barrels a day in April (again, according to the delegate).

Bloomberg notes that crude traders had widely expected that OPEC+ would once again delay the restart, which it had postponed three times since first announcing a supply roadmap last June.

“The optics around any reinstatement of supply, even if incremental and small, will be seen as price-negative,” Harry Tchilinguirian, head of oil research at Onyx Commodities Ltd., told Bloomberg before the decision.

Crude prices immediately plunged back below $70 (WTI) on the headline...

..taking out 2025 lows...

The group’s choice may be yet another illustration of the sway of Trump, who last month called on OPEC to “cut the price of oil.”

Additionally, Trump’s renewed “maximum pressure” on Iranian exports could create a gap for other OPEC+ nations to fill.

It wouldn't be the first time that a headline was run ahead of an OPEC+ meeting to run stops, and we wonder what's the over/under on the timing of an official OPEC+ denial.

https://www.zerohedge.com/energy/oil-prices-plunge-opec-delegate-hints-output-hikes-due-trump-pressure

Safer Antiplatelet Routines, Non-Statin Meds Feature in New Heart Attack Guidelines

 

• Guidelines continue to recommend standard dual antiplatelet therapy while endorsing de-escalating therapy and monotherapy for some patients.
• Non-statin lipid-lowering therapies make their debut for secondary prevention in the updated guidelines.
• Home-based cardiac rehabilitation is deemed a reasonable alternative to center-based rehab.

In updated American recommendations for the management of acute coronary syndrome (ACS), bleeding reduction strategies on antiplatelet therapy are embraced, as are non-statin lipid-lowering therapies for secondary prevention.

The newly released 2025 ACS guideline from the American College of Cardiology and the American Heart Association still have default dual antiplatelet therapy (DAPT) as a Class I recommendation, the standard being at least 12 months of it after hospital discharge for patients with low bleeding risk.

However, the guideline, published jointly in the Journal of the American College of Cardiologyopens in a new tab or window and Circulation, also lays out more bleed-safe alternatives to the standard DAPT regimen for people with unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI):

• Selected patients can transition from DAPT to ticagrelor (Brilinta) monotherapy a month or later after percutaneous coronary intervention (PCI; Class I)
• A proton pump inhibitor can be added for those at high risk of gastrointestinal bleeding (Class I)
• De-escalation of DAPT from ticagrelor or prasugrel (Effient) to clopidogrel (Plavix) may be reasonable at least a month after PCI (Class IIb)
• Those at high bleeding risk can transition to single antiplatelet therapy (either aspirin or P2Y12 inhibitor) after 1 month (Class IIb)

These are major changes since the last DAPT guideline, from 2016opens in a new tab or window, which had only mentioned shorter-duration DAPT as a consideration for ACS patients at lower ischemic risk with high bleeding risk (Class IIb).

"Patients with ACS are at the highest risk for cardiovascular complications both acutely and chronically, which emphasizes the importance of staying up-to-date on the most recent evidence presented in this guideline," said guideline writing committee chair Sunil Rao, MD, of NYU Langone Health in New York City, in a press release. "With appropriate management, we can improve outcomes both in the hospital and over the long term."

The new guideline also introduces non-statin lipid-lowering therapies -- such as ezetimibe (Zetia), evolocumab (Repatha), alirocumab (Praluent), inclisiran (Leqvio), and bempedoic acid (Nexletol) -- for secondary prevention in ACS survivors.

Statin users with an LDL cholesterol ≥70 mg/dL are strongly urged to take a concurrent non-statin lipid-lowering agent to further reduce the risk of major adverse cardiovascular events (Class I), while those with LDL cholesterol at 55-69 mg/dL, already on a maximally tolerated statin, may reasonably add one of these therapies to reduce the risk of major adverse cardiovascular events (Class IIa).

All ACS patients starting or adjusting a dose of lipid-lowering therapy should have a fasting lipid panel taken 4-8 weeks later to gauge response or additional medications that may be needed (Class I).

Another important aspect of secondary prevention is referral to outpatient cardiac rehabilitationopens in a new tab or window prior to hospital discharge, which is strongly endorsed to reduce death, myocardial infarction, and hospital readmissions and improve functional status and quality of life (Class I).

Home-based cardiac rehabilitation is deemed a reasonable alternative (Class IIa), but more research is needed to see whether this model provides the same benefit as facility-based programs and makes good on its promise of better adherence, according to Rao's group.

The 2025 guideline also now has intravascular imaging (intravascular ultrasound or optical coherence tomography) as a class I recommendation to guide PCI.

Finally, patients with STEMI and cardiogenic shock may receive a microaxial flow pumpopens in a new tab or window with careful attention paid to vascular access and the weaning of support (Class IIa).

The new ACS guideline was written in collaboration with and endorsed by the American College of Emergency Physicians, the National Association of EMS Physicians, and the Society for Cardiovascular Angiography and Interventions.

Guideline writers acknowledged unanswered questions in this setting, including the potential role of GLP-1 receptor agonists and colchicine after ACS.

Disclosures

Rao declared no relevant disclosures.

Other guideline committee members had various ties to industry.

Primary Source

Journal of the American College of Cardiology

Source Reference: opens in a new tab or windowRao SV, et al "2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" J Am Coll Cardiol 2025; DOI: /10.1016/j.jacc.2024.11.009.

https://www.medpagetoday.com/cardiology/acutecoronarysyndrome/114424

'Cattle Farmers Face Bird Flu Fears'

 A second variant of bird flu has been discovered in US dairy cows. The USDA found the new strain in the milk of two cows in Nevada. An older strain was linked to over 900 herds of cattle across 16 states. Patrick Montgomery, chief executive officer of Valor Provisions, a direct-to-consumer sales platform, discusses the bird flu concerns, pending tariffs and other issues facing American farmers. He speaks on "Bloomberg Open Interest."

Bloomberg videos, provided by MT Newswires

https://www.marketscreener.com/news/latest/Cattle-Farmers-Face-Bird-Flu-Fears-49220853/

Putin-Trump Summit Being Expedited In Wake Of Zelensky White House Row

 CNN reports that a summit between Presidents Trump and Putin is now being fast-tracked in the wake of the explosive row with Zelensky, which saw him booted from the White House before a planned lunch was to take place Friday.

Last month saw talks in Riyadh aimed at fully restoring US-Russia relations end on a positive note between the delegations headed by Rubio and Lavrov. There was a follow-on meeting in Istanbul, leading to the restaffing of embassies (which had previously seen a tit-for-tat booting of diplomatic staff under the Biden admin).

CNN writes in a fresh Monday report, "Whether it was orchestrated or not, Moscow – which reacted with glee to the White House slanging match – is now anticipating talks aimed at rebuilding the US-Russia relationship will continue, even accelerate, in the weeks ahead."

AFP/Getty Images

"Nothing has been announced in public. But, privately, there’s talk of the Trump-Putin summit, always on the cards, now being fast-tracked," the report continues.

"There is also renewed optimism in Moscow that, with President Zelensky at odds with President Trump and his team, difficult negotiations to end the war in Ukraine will now take a back seat to a raft of potentially lucrative US-Russia economic deals already being tabled behind closed doors," CNN adds.

US National Security Advisor Mike Waltz has meanwhile warned Zelensky not to test the limits of American patience. He strongly suggested in a fresh Fox interview that Zelensky is fully rejecting the possibility of ceasefire in the over three-year long conflict.

"[Zelensky] is not ready to talk peace at all. Here is the problem, time is not on his side. Time is not on the side of just forever continuing this conflict," Waltz said on Fox.

"It was really confounding to us that Zelensky could have left the White House Friday having the US and Ukraine bound together economically for a generation," Walz said in reference to the rare earth minerals deal that was supposed to be signed.

Still, Ukraine's Zelensky says US support is "crucial" as he attempts to salvage the relationship. After being accused of being ungrateful by Vice President JD Vance on Friday, Zelensky spent the weekend tweeting out a serios of 'thank you' messages, and also at one point expressed: "It’s crucial for us to have President Trump’s support."

Even the Biden administration long complained that Zelensky seemed ungrateful for the tens of billions Washington has devoted to the war effort:

He said in a series of posts on X Saturday morning of Trump, "He wants to end the war, but no one wants peace more than we do." Zelensky has stressed that he sees this as impossible without strong security guarantees, however.

https://www.zerohedge.com/geopolitical/putin-trump-summit-being-expedited-wake-zelensky-white-house-row

Lower Government Spending Will Not Weaken The US Economy. It Will Strengthen It

 by Daniel Lacalle,

The Federal Reserve Bank of Atlanta’s GDPNow model projection for real GDP growth in the first quarter of 2025 (Q1 2025) is now showing a slump to -1.5%. This marks a significant downward revision from the previous estimate of 2.3% on February 19, 2025.

Such an enormous decline is strange. How did we go from +2.3% to -1.5% in less than a month? That kind of collapse in an economy as large as the United States is exceedingly rare. [ZH: It's even worse now, as we detailed earlier.]

The immediate reaction from the media is to call this the beginning of a “Trump recession” and blame it on President Trump’s policies. Interestingly, on June 1, 2022, the Atlanta Fed GDPNow estimated the second quarter of 2022 growth at +1.3%. By July 1, 2022, it had dropped to -2.1%, a shift of 3.4 percentage points in 30 days. What did the media call it? “Growth scare”. A similar thing happened in the third quarter of 2021. The estimate fell from 6.1% (July 30) to 2.3% (October 1), a 3.8-point drop over two months.

In 2022, real GDP declined for two consecutive quarters under Biden’s administration. According to the Bureau of Economic Analysis, the first quarter saw a decrease of -1.6% in the annualised rate, followed by a 0.6% drop in the second quarter. Hundreds of analysts, commentators, and economists, along with the NBER, swiftly declared that this was not a recession. Thus, it is hilarious to read the hundreds of comments arguing that the Atlanta Fed NowCast means that the new administration’s policies are causing a recession.

As I wrote a few months ago, the United States has been in a private sector recession for months. However, an abnormal increase in government spending during a period of growth and a risky borrowing policy led to a bloated Gross Domestic Product (GDP).

The United States had a $7.59 trillion nominal GDP increase between 2021 and 2024 compared to a rise of $8.47 trillion in government debt. This marks the worst GDP growth adjusted for government debt accumulation since the 1930s.

Many analysts are warning that the Department of Government Efficiency (DOGE) efforts will cause a recession if government spending is aggressively reduced. However, cutting spending may “reduce” GDP but does not harm productive economic growth; it will likely strengthen it.

We must remember that US government spending financed by increasing federal debt accounted for about 22% to 25% of the total US GDP growth over 2021–2024. This extraordinary increase in government spending in the middle of a recovery led to record-high government debt and was the leading cause of money supply growth and, with it, the inflation burst that Americans are suffering today.

A research study from MIT Sloan published on July 17, 2024, by Mark Kritzman et al., titled “The Determinants of Inflation,” concluded that federal spending was the overwhelming driver of the inflation spike in 2022, estimating it was two to three times more significant than any other factors.

Government spending was out of control, leading money supply growth to soar, and the cumulative inflation suffered by Americans in the past four years is over 20.9%, with groceries and gas prices rising by more than 40%.

Excessive government spending was not only the cause of the rise in money supply growth and the burst of inflation but also led to an $8.47 trillion increase in debt and an unsustainable path to financial ruin if policies remained the same. According to the Congressional Budget Office, with no policy changes, the United States would have accumulated deficits of $12.6 trillion between 2025 and 2030. Net interest outlays were expected to grow from $881 billion in 2024 to $1.2 trillion by 2030, even assuming no recessions or unemployment increases.

Cutting government spending is essential to reduce prices, bring inflation under control and stop the looming public finance disaster. By 2024, it became evident that revenue measures would not reduce the United States federal deficit. Deficits are always a spending problem.

We must remember that 2024’s 2.8% GDP growth reflected almost $2 trillion in borrowing, a roughly one-to-one spending-to-growth ratio and a dangerous path to a debt crisis.

Private GDP should measure the economy, as government spending and debt do not drive productive growth. Stripping government spending can give us a more accurate picture of the reality of the productive sector in America. The latest Atlanta Fed estimates show a massive decline in net exports (-3.7%) due to a large increase in imports, a small decline in consumption of goods (-0.09%) but strong services (+0.62%) and rises in government expenditure (+0.34%) and a healthy increase in investment (+0.62%). Thus, the surprising factor is an abnormal slump in exports and a rise in imports that may be revised, because the trade deficit in December 2024 rose to a record $98.4 billion and GDP did not reflect such a massive slump in net exports. The concerning thing is that government spending continues to be excessive, and the United States is running an annualised $2.5 trillion deficit.

The United States will not enter a recession due to the change of administration, but because of the excess spending policies of the Biden years. Reducing federal spending, deficit, and debt accumulation is essential to recover the health of the economy.

Bloating GDP with public spending and debt is not growing; it is the recipe for disaster.

https://www.zerohedge.com/economics/lower-government-spending-will-not-weaken-us-economy-it-will-strengthen-it