RELEASE DATE: June 12, 2013
EXPIRATION DATE: June 11, 2014
Target AudienceRheumatologists, primary care clinicians, including family physicians, internists, hospitalists and physician assistants.
Statement of Need
Based on a number of studies, it is clear that the treatment of early RA is neither adequately prompt nor aggressive. Studies have repeatedly shown that biologic agents, are more effective in patients with early RA versus those patients with more advanced disease.1-6 Still, despite this great body of evidence among the literature for early treatment, patients often do not receive appropriate treatment. For instance, results from a treatment survey of 16,752 newly diagnosed RA patients in the United States indicated that only 26% received biologic DMARDs.7 Simply put, almost three-quarters of patients who could significantly benefit from therapy did not receive it. This lack of treatment is a key reason that a number of patients diagnosed with early RA end up with significant disease activity after three years despite follow-up and later treatment.8
Prescribing a single agent for RA does not result in effective treatment of the disease. Despite studies that show provide clear guidelines for therapy, many physicians do not adequately treat RA, including switching patients from one regimen to another. A survey of 492 rheumatologists demonstrated that 41% of their patients had active disease and that therapy was still not changed among these individuals.9 Another survey of 500 rheumatologists indicated that only 47% switched anti-TNF agents when only a partial response was experienced by a patient to the first agent.10 Notably, this clinical inertia exists despite clear guidelines regarding when to switch treatment and the also clear flowchart/decision trees to guide appropriate selection of second-line pharmacotherapy.11
- Cush JJ. Early rheumatoid arthritis – is there a window of opportunity? J Rheumatol Suppl. 2007;80:1-7.
- Roberts LJ, Cleland LG, Thomas R, Proudman SM. Early combination disease modifying antirheumatic drug treatment for rheumatoid arthritis. Med J Aust. 2006;184:122-125.
- Scott DL. Early rheumatoid arthritis. Br Med Bull. 2007;81-82:97-114.
- Sizova L. Approaches to the treatment of early rheumatoid arthritis with disease-modifying antirheumatic drugs. Br J Clin Pharmacol. 2008;66:173-178.
- Mader R, Keystone E. Optimizing treatment with biologics. J Rheumatol Suppl. 2007;80:16-24.
- Gibofsky A. Combination therapy for rheumatoid arthritis in the era of biologicals. HSS J. 2006;2:30-41.
- Yazici Y, Shi N, John A. Utilization of biologic agents in rheumatoid arthritis in the United States: analysis of prescribing patterns in 16,752 newly diagnosed patients and patients new to biologic therapy. Bull NYU Hosp Jt Dis. 2008;66:77-85.
- Kiely P, Williams R, Walsh D, Young A; Early Rheumatoid Arthritis Network. Contemporary patterns of care and disease activity outcome in early rheumatoid arthritis: the ERAN cohort. Rheumatology (Oxford). 2009;48:57-60.
- Saraux A, Devauchelle-Pensec V, Engerran L, Flipo RM. Most rheumatologists are conservative in active rheumatoid arthritis despite methotrexate therapy: results of the PRISME survey. J Rheumatol. 2006;33:1258-1265.
- Medical News Today. More can be done to improve outcomes in patients with rheumatoid arthritis, survey. 2005. Available at: http://www.medicalnewstoday.com/articles/25932.php
- Fautrel B, Guillemin F, Meyer O, et al. Choice of second-line disease-modifying antirheumatic drugs after failure of methotrexate therapy for rheumatoid arthritis: a decision tree for clinical practice based on rheumatologists’ preferences. Arthritis Rheum. 2009;61:425-434.
Learning ObjectivesAt the conclusion of this activity, participants will be able to:
- Increase the use of appropriate pharmacotherapy among physicians who treat patients with rheumatoid arthritis (RA).
- Improve the use of guidelines for initiating and changing therapeutic regimens in the treatment of RA.
- Video Presentation
Faculty Information & Disclosures
Philip L. Cohen, MD
Section Chief, Rheumatology Professor, Medicine Professor, Microbiology and Immunology Temple University School of Medicine Philadelphia, PA
Philip L. Cohen, MD, is section chief of rheumatology, professor of medicine, and professor of microbiology and immunology at Temple University Hospital in Philadelphia. Dr. Cohen’s research interests include the mechanisms of systemic lupus and Sjogren’s syndrome.
A graduate of the Yale University School of Medicine in New Haven, CT, Dr. Cohen was an internal medicine resident at New York-Presbyterian Hospital/Columbia University Medical Center in New York City and received research training in immunology and rheumatology at the National Institutes of Health in Bethesda, MD and the University of Texas Southwestern Medical School in Dallas.
Dr. Cohen was a faculty member at the University of North Carolina School of Medicine in Chapel Hill and the University of Pennsylvania in Philadelphia, before moving into his current position.In accordance with the Food and Drug Administration, the speakers have disclosed that there is the potential for discussions concerning off-label uses of a commercial product/device during this educational activity. Any person who may contribute to the content of this continuing education activity must disclose significant relationships (and any known relationships of their spouse/partner) with commercial companies whose products or services are discussed in educational presentations. Significant relationships include receiving from a commercial company research grants, consultant fees, travel, other benefits, or having a self-managed equity interest in a company. Disclosure of a relationship is not intended to suggest or condone any bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Philip L. Cohen, MD has disclosed that he receives research dollars from Janssen Biotech, Inc. The planners and managers have no financial or other relationship to products or devices with commercial interests related to the content of this CME activity.
InstructionsTo receive a statement of credit, you must:
- Review the full content of the activity.
- Successfully complete the post-test (80% or better).
- Complete the evaluation at the end of the activity.
- Statements of credit will be issued immediately online upon successful completion of the post-test/evaluation.
PhysiciansIn support of improving patient care, Creative Educational Concepts, Inc. (CEC) is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for the healthcare team. CEC designates this enduring educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
FeeThis activity is complimentary.
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Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
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Unlabeled Use DisclosureThis activity may include discussions of products or devices that are not currently approved for use by the Food and Drug Administration (FDA), or are currently investigational.
Supporting OrganizationThis activity is supported by an independent educational grant from Genentech.
Required Computer Hardware/Software
- A broadband internet connection
- Operating system: Microsoft Windows XP or later; Mac OS X 10.4 or later; iOS 5.0 or later
- Web browser: Microsoft Internet Explorer 7.0 or later; Mozilla Firefox; Google Chrome; Apple Safari; Apple Mobile Safari
- Adobe Flash Player 9.0 or later (Available at: http://get.adobe.com/flashplayer/), if running on desktop