Treatment Recommendations and Managed Care Considerations for Patients With Rheumatoid Arthritis

For patients with rheumatoid arthritis (RA) who continue to have moderate to severe disease activity despite treatment with conventional disease modifying antirheumatic drugs (DMARDs), tumor necrosis factor (TNF) inhibitors have long been a mainstay in treatment protocol. However, recent years have witnessed considerable evidence on the efficacy and safety of biologic therapies for RA that act through mechanisms other than TNF inhibition. Accordingly, in November 2015, the American College of Rheumatology (ACR) released new guidelines that address the use of DMARDs, TNF inhibitors, non-TNF biologics, and small molecule agents in treatment of both early and established RA.

New clinical evidence, treatment recommendations, and their resulting implications for managed care decision-making were central themes discussed during a satellite symposium provided by PRIME Education, Inc. (PRIME) at AMCP. Faculty included Mark Genovese, MD, professor of medicine and co-chief of the Division of Immunology & Rheumatology at Stanford University; Ewa Olech, MD, medical director at Quintiles and adjunct associate professor of Internal Medicine at the University of Nevada, Las Vegas School of Medicine, Kamala M Nola, PharmD, MS, vice chair and professor at Lipsocomb College of Pharmacy.

Dr Nola opened the program with a discussion on key barriers to evidence-based care in treating RA, including delays in treatment initiation, variation in disease activity measurement, the need for biomarkers, and issues pertaining to proper medication adherence. Next, Dr Genovese highlighted the growing number of comparative efficacy studies in RA, and discussed recent phase 3 clinical trial evidence on the safety and efficacy of emerging anti-interleukin (IL)-6 agents and Janus kinase (JAK) inhibitors. The program then moved into a discussion led by Dr Olech on the 2015 ACR guideline recommendations and the challenging decision of whether to cycle TNF inhibitors or swap to a non-TNF agent after TNF inhibitor failure. The program concluded with an interactive panel and participant discussion on the patient populations that will derive the most benefit from novel RA therapies and collaboration among the interprofessional team to drive patient-centered care. 

The program was supported by educational grants from Sanofi US and Regeneron Pharmaceuticals, Inc.