A Sunday symposium will review emerging comparative effectiveness research in small molecule and biologic therapies for rheumatoid arthritis (RA), the role of imaging in the clinical care of RA, and how to address infection risk when using these medications.
The symposium, Update in RA: Benefits & Harms of Biologics & Small Molecules & Imaging Strategies, will take place from 4:30 – 6:00 pm Sunday in Room 20 D. Mark C. Genovese, MD, the James W. Raitt Professor of Medicine in the Division of Immunology and Rheumatology at Stanford School of Medicine in Palo Alto, CA, will discuss the impact of biologics and small molecules in RA treatment.
“Since their introduction, we’ve seen meaningful improvements with the use of biologics and small molecules, not only in clinical trials, but also in real-world data,” Dr. Genovese said. “While we’ve yet to maximize all of the potential benefits of our existing therapies, from either a treat-to-target or a combination approach, a further understanding of the utility and the ramifications of small molecule and biologic therapies will play a key role in the future treatment of RA.”
Peter C. Taylor MA, PhD, FRCP, the Norman Collisson Professor of Musculoskeletal Sciences and Head of Clinical Sciences at the University of Oxford in the U.K., will follow with a discussion on the role of imaging in assessing disease activity in RA.
“Other than looking for structural damage to the joint, for which we still use plain radiographs by and large, there are many different imaging modalities that could potentially be used to gain additional information about inflammatory disease activity in rheumatoid arthritis,” Dr. Taylor said. “Ultrasonography and magnetic resonance imaging (MRI), for example, have the potential, particularly in early-phase disease, to detect synovitis that might otherwise be subclinical.”
Ultrasound and MRI, he said, could also be used to quantify local inflammation with greater accuracy than is possible with a clinical joint assessment, which may not have much application in clinical practice but may be useful in clinical trials.
“In the context of clinical research, imaging may have value as a more sensitive measure of change and, potentially, could give us an idea as to how efficacious a drug is in an early stage of drug development,” Dr. Taylor said. “Additionally, imaging research points to the use of imaging biomarkers as having prognostic value in terms of predicting the likelihood of structural damage progression, which might help inform a treatment choice.”
The final presenter, Kevin L. Winthrop, MD, MPH, Professor of Public Health and Associate Professor of Infectious Diseases and Ophthalmology at the School of Public Health and School of Medicine at Oregon Health & Science University in Portland, will talk about ways to manage and prevent infections in RA patients.
“There’s quite a bit of research coming out on Janus kinase (JAK) inhibitors right now and how they compare to the biologics with regards to infection,” Dr. Winthrop said. “There has been some interesting data published recently about mitigating shingles risk with JAK inhibitors, for example, including a study where patients were vaccinated with Zostavax prior to starting the JAK inhibitor tofacitinib, and it appeared to have a significant immunogenic effect.”
Dr. Winthrop will also emphasize the importance of screening patients for latent viral infections, such as tuberculosis and hepatitis B, before administering small molecule or biologic therapy in order to mitigate the risk of active infection.
“There are also some emerging infections, such as chikungunya virus, that may not be on rheumatologists’ radar screen yet, but they will be,” Dr. Winthrop said. “The bottom line is that we have a wave of new therapies coming along and they all potentially raise the risk of serious bacterial and opportunistic infections, so we need to be screening patients before administering these therapies.”