Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease

Taylor, Peter C; Askari, A; Choy, E; Ehrenstein, M.R; Else, S; Nisar, M.K

Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease

Authors

Taylor, Peter C

Askari, A

Choy, E

Ehrenstein, M.R

Else, S

Nisar, M.K

Issue Date

2023

Type

Scientific Paper

Keywords

Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Rheumatology

Abstract

Abstract Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with joint pain and stiffness. Biologics represent some of the most effective treatments for RA, but previous guidance from the National Institute for Health and Care Excellence (NICE) has limited their use to patients with severely active disease. This has meant patients with moderately active RA have been treated as if they have an acceptable disease state, despite many cases where the inflammation has a major impact on joint damage, mobility, pain and quality of life. However, recent guideline changes (NICE TA715) have approved the use of three biologics - adalimumab, etanercept and infliximab - for the treatment of moderately active RA. Main body: In response to these changes, we have held discussions with medical teams from across the UK to consider the main implications for implementation of these new recommendations, as well as any differences in approach that may exist at a local level. Several key challenges were identified. These included establishing methods of educating both physicians and patients concerning the new availability of the biologic treatments, with suggestions of various organisations that could be approached to circulate informative material. Identifying which patients with moderately active RA stand to benefit was another discussion topic. Relying solely on scoring systems like Disease Activity Score in 28 Joints (DAS28) was acknowledged to have limitations, and alternative complementary approaches such as ultrasound, as well as assessing a patient's co-morbidities, could also be useful tools in determining those who could benefit from biologics. An additional challenge for the process of patient identification has been the increase in the use of telemedicine consultations in response to the coronavirus disease 2019 (COVID-19) pandemic. More use of patient-reported outcomes was raised as one possible solution, and the importance of maintaining up-to-date databases on patient disease scores and treatment history was also stressed. Conclusion: While challenges exist in education and identifying patients who may benefit from the use of biologics, the NICE TA715 recommendations hold great potential in addressing an unmet need for the treatment of moderate RA. Keywords: Biologics; Biosimilars; Moderate rheumatoid arthritis; National Institute for Health and Care Excellence (NICE); Telemedicine. © 2023. The Author(s). PubMed Disclaimer Conflict of interest statement PCT has received research grants from Galapagos and Consultation fees from AbbVie, Biogen, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Nordic Pharma, Fresenius and UCB. EC has received research grants and served as a member of advisory boards and speaker bureaus of Abbvie, Allergan, Amgen, AstraZeneca, Bio-Cancer, Biocon, Biogen, BMS, Boehringer Ingelheim, Celgene, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Fresenius Kabi, Ferring Pharmaceutical, Galapagos, Gilead, GSK, Hospira, ISIS, Jazz Pharmaceuticals, Janssen, MedImmune, Merck Serono, Merrimack Pharmaceutical, MSD, Napp, Novimmune, Novartis, ObsEva, Pfizer, Regeneron, Roche, R-Pharm, Sanofi, SynAct Pharma, Synovate, Tonix and UCB. MRE has received consultation fees from GlaxoSmithKline, Galapagos, Fresenius and AstraZeneca. SE has served as a member of advisory boards and received support (including attendance at conferences, speaker fees and honoraria) from Abbvie, Biogen, BMS, Celgene, Fresenius Kabi, Grifols, Janssen, MSD, Novartis, Roche and UCB. MKN undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis, Fresenius Kabi, Lilly, Galapagos, Nordic Pharma and UCB. Figures Fig. 1 Fig. 1 Summary of the main challenges… Similar articles A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Chen YF, Jobanputra P, Barton P, Jowett S, Bryan S, Clark W, Fry-Smith A, Burls A. Health Technol Assess. 2006 Nov;10(42):iii-iv, xi-xiii, 1-229. doi: 10.3310/hta10420. PMID: 17049139 Review. Real-world Effectiveness of Biologic Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis After Etanercept Discontinuation in the United Kingdom, France, and Germany. Li N, Betts KA, Messali AJ, Skup M, Garg V. Clin Ther. 2017 Aug;39(8):1618-1627. doi: 10.1016/j.clinthera.2017.06.009. Epub 2017 Jul 17. PMID: 28729087 Associations between an expanded autoantibody profile and treatment responses to biologic therapies in patients with rheumatoid arthritis. Petro AD, Dougherty J, England BR, Sayles H, Duryee MJ, Hunter CD, Kremer JM, Pappas DA, Robinson WH, Curtis JR, Thiele GM, Mikuls TR. Int Immunopharmacol. 2021 Feb;91:107260. doi: 10.1016/j.intimp.2020.107260. Epub 2020 Dec 23. PMID: 33360371 Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis: a systematic review and economic evaluation. Rodgers M, Epstein D, Bojke L, Yang H, Craig D, Fonseca T, Myers L, Bruce I, Chalmers R, Bujkiewicz S, Lai M, Cooper N, Abrams K, Spiegelhalter D, Sutton A, Sculpher M, Woolacott N. Health Technol Assess. 2011 Feb;15(10):i-xxi, 1-329. doi: 10.3310/hta15100. PMID: 21333232 Free PMC article. Review. Delineation of the distinct inflammatory signaling roles of TAK1 and JAK1/3 in the CIA model of rheumatoid arthritis. Freeze R, Yang KW, Haystead T, Hughes P, Scarneo S. Pharmacol Res Perspect. 2023 Aug;11(4):e01124. doi: 10.1002/prp2.1124. PMID: 37564034 Free PMC article. See all similar articles Cited by Charting the Etanercept Journey: Tracing Cost Dynamics in Poland's Off-Patent Market from Reference Drug Rivalry to Biosimilar Monopoly. Stajszczyk M, Batko K, Żuber ZM, Kwiatkowska B, Krajewska-Włodarczyk M, Batko B. BioDrugs. 2024 Jul;38(4):557-569. doi: 10.1007/s40259-024-00663-4. Epub 2024 Jun 11. PMID: 38861154 Free PMC article. References Taylor PC, Woods M, Rycroft C, Patel P, Blanthorn-Hazell S, Kent T, Bukhari M. Target literature review of current treatments and unmet need in moderate rheumatoid arthritis in the United Kingdom. Rheumatology (Oxford). 2021;60:4972–4981. doi: 10.1093/rheumatology/keab464. - DOI - PMC - PubMed Martin CR, Preedy VR. Scientific basis of healthcare: arthritis. Boca Raton, Florida, US: Taylor & Francis; 2012. Nikiphorou E, Jacklin H, Bosworth A, Jacklin C, Kiely P. Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society. Rheumatol Adv Pract. 2021;0:1–9. - PMC - PubMed Radner H, Smolen JS, Aletaha D. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther. 2014;16:R56. doi: 10.1186/ar4491. - DOI - PMC - PubMed Nikiphorou E, Norton S, Young A, Carpenter L, Dixey J, Walsh DA, Kiely P. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Ann Rheum Dis. 2016;75:2080–2086. doi: 10.1136/annrheumdis-2015-208669. - DOI - PMC - PubMed Show all 48 references Publication types Research Support, Non-U.S. Gov't MeSH terms Antirheumatic Agents* / therapeutic use Arthritis, Rheumatoid* / drug therapy Biological Products* / therapeutic use COVID-19* Humans Quality of Life Tumor Necrosis Factor Inhibitors / therapeutic use Substances Antirheumatic Agents Tumor Necrosis Factor Inhibitors Biological Products Related information MedGen LinkOut - more resources Full Text Sources BioMed Central Europe PubMed Central PubMed Central Medical MedlinePlus Health Information

Citation

Taylor PC, Askari A, Choy E, Ehrenstein MR, Else S, Nisar MK. Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease. BMC Med. 2023 Feb 14;21(1):55. doi: 10.1186/s12916-023-02746-5. PMID: 36782189; PMCID: PMC9925364.