Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease
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Authors
Taylor, Peter C
Askari, A
Choy, E
Ehrenstein, M.R
Else, S
Nisar, M.K
Issue Date
2023
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Rheumatology
Alternative Title
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).
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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.
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Fig. 1 Summary of the main challenges…
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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
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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.