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The latest in RA therapies, and what you can expect from the pipeline.
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that characteristically affects the joints of the hands and feet, causing inflammation, swelling, pain, and progressive destruction of articular structures. RA affects about 1% of the population; onset may occur at any age but most often occurs between ages 35 and 50 years, according to The Lancet.
“The main treatment goals with rheumatoid arthritis are to control inflammation, relieve pain, and reduce associated disability,” said Julie Rubin, director of clinical services, CompleteRx. “Treatment usually includes medications, occupational or physical therapy, regular exercise, and in more extreme cases, surgery to correct joint damage.”
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Traditional medications for RA include nonsteroidal anti-inflammatories (NSAIDs) and steroids to help reduce inflammation, and disease-modifying anti-rheumatic drugs (DMARDs). “Methotrexate is the main therapy in the class of DMARDs but others include hydroxychloroquine, leflunomide, and sulfasalazine,” says Rubin.
Management and treatment strategies of RA has evolved over the last two decades due to the advent of biologics. Enbrel (etanercept, Amgen) was FDA approved in 1998, becoming the first biologic indicated for the treatment of RA. Since Enbrel, several other biologic medications have been approved for treatment of RA including Remicade (infliximab, Janssen), Humira (adalimumab, AbbVie), and Rituxan (rituximab, Genentech).
“Many of these drugs can be expensive, even with healthcare or Medicare coverage,” says Ashraf Shehata, advisory principal at KPMG and a member of the firm’s Global Healthcare Center of Excellence. “Higher out-of-pocket costs can be a compliance issue for patients and the high cost of these drugs tend to front load that burden on patients early in the year.”
Actemra (tocilizumab, Roche), an interleukin-6 (IL-6) receptor antagonist.
Xeljanz (tofacitinib, Pfizer), a JAK [Janus kinase] inhibitor.
Kevzara (sarilumab, Sanofi and Regeneron), an IL-6 receptor antagonist.
Olumiant (baricitinib, Eli Lilly), a JAK inhibitor.
“There are a fair number of alternatives to help patients manage this condition,” says Shehata. “The biologic drugs are expensive, but they help keep the condition in check and could help avoid surgeries and disability costs.”
“Biosimilars could take some of the sting from the costs of RA drugs and several are on the market,” says Shehata. “Health plans need to consider whether the convenience of JAK inhibitors, which are administered orally, adds more value than the savings from injectable biosimilars.”
Erelzi (etanercept-szzs), biosimilar to Enbrel (etanercept, Amgen), but not interchangeable with Enbrel.
Amjevita (adalimumab-atto) and Cyltezo (adalimumab-adbm), both approved biosimilars to Humira (adalimumab, AbbVie).
Inflectra (infliximab-dyyb), bioimilar to Remicade (infliximab, Janssen).
Upadacitinib (AbbVie), an investigational, oral, JAK-1 selective inhibitor.
âOlokizumab (R-Pharm), an investigational, subcutaneous, IL-6 antagonist
Filgotinib (Gilead and Galapagos), an investigational, oral, JAK-1 selective inhibitor
Erin Johanek, PharmD, RPh, is a staff pharmacist at Southwest General Health Center, Middleburg Heights, Ohio.