More research is supporting a host of next-generation treatments for RA, with a new study out of Denmark crediting these treatments for a reduction in joint replacements in RA patients.
René Lindholm Cordtz, PhD, a rheumatology expert from Denmark, who coauthored the report in the Annals of the Rheumatic Diseases, notes that next-generation medications for RA, such as biologics, have transformed the face of the disease over the last two decades. Particularly, newer medications have improved the outlook for RA patients in terms of joint health.
His study found that since biologics were introduced to treat RA, fewer RA patients in Denmark have required total knee replacements. While new RA therapies can be costly, Cordtz says it’s important to note the savings in terms of nonmedical costs of RA (lost wages and productivity, decreased quality of life) as well as the avoided costs of joint replacement surgery.
“We hope our study motivates clinicians and patients to keep on committing to an aggressive treatment strategy including early use of biologics in case of nonsufficient effect of conventional DMARDs,” Codtz says. “Our main message is that the need for major surgeries such as total hip and knee arthroplasty has decreased among newly diagnosed rheumatoid arthritis patients in Denmark following introduction of biologics, although more aggressive treatment with conventional DMARDs and the treat-to-target strategy could also have contributed to this finding. During the same period, the use of these surgeries increased in the general population of Denmark.”
A more precise approach
When it comes to choosing which of the many RA treatments is appropriate for a particular patient, Cohen says there are two schools of thought. One is to follow the American College of Rheumatology’s algorithm and guidelines for treatment. This option, however, doesn’t always fit a patient’s needs.
“The plan for RA is to use methotrexate or similar first. The next step for those whose disease doesn’t respond to methotrexate therapy is to move on to add a biologic, usually an anti-TNF,” Cohen says. “But the algorithm doesn’t always work because it doesn’t always fit the patient.”
The second approach is to consider the patient’s individual needs, she says.
“If a patient consumes more than a few drinks per week, methotrexate is not the medication of choice. If a woman wants to have kids, then maybe use an older DMARD like Plaquenil. Some patients may have an aversion to needles of infusions,” Cohen says. “It’s not a one-size-fits-all plan.”
Another consideration is cost, she warns.
“It sounds like the world is our oyster and we have so many medications to choose from, but that’s not the case. Often, insurance companies will tell us what a patient can use,” Cohen says.