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Cush offers drug 'safety rules to live by' for rheumatologists
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DESTIN, Fla. — The riskiest thing you can do, when it comes to managing treatments for patients with rheumatic diseases, is to “play it safe,” according to John J. Cush, MD, director of clinical rheumatology for Baylor Scott & White Research Institute and professor of medicine and rheumatology at Baylor University Medical Center at Dallas.
“Safety is all about risk,” Cush said during a presentation here. “It’s all about not knowing what you don’t know, and I think that’s a big problem. The problem is that we then tend to veer away from those things which might actually be a little bit risky and we may not be totally certain about, and then who loses out? Either you lose out or the patient loses out, and I think maybe sometimes you spend more effort than you need to on that patient.”
Cush shared his drug “safety rules to live by” with the audience:
1. The longer you’re on a drug, the safer it becomes.
According to Cush, patients are usually surprised when they learn this; they think because they’ve been on methotrexate for 4 or 11 years, that they’re damaging their liver and the drug is going to kill them. The problem is compounded by TV ads reminding them of the “dangers” the drugs possess.
“You have to remind them that all the stuff is front-loaded — all the things that are going to happen are usually in the first 6 months. After that, if it happens it’s serendipity or there is another reason,” he said.
2. Lower doses are not always safer.
Patients may think taking half their prescribed dose will do less harm to organs like the pancreas, but in reality, taking lower doses may be harmful.
“Lower doses mean less effect, less effect means more disease, and more disease means you’re in trouble.”
3. Never let someone who knows less than you manage your prescriptions.
Similarly, don’t allow them to give you advice or tell your patient what to do.
“Everyone gets their information about these drugs that you’re an expert on from television, not because they studied it like you studied it. They don’t review this at conferences like this.”
4. The riskiest thing may be to “ play it safe. ”
Cush noted one exception to this rule: It’s okay to “play it safe” when there isn’t “too much to worry about.”
“When there’s a lot to worry about, you have to sort of match the aggressiveness of the disease, and you and the patient have to know and accept the risks.”
5. The safest thing is to know and accept the risk.
“Who’s in the risk business? You’re in the risk business. If you’re not willing to accept and understand the risk, then go into podiatry, or become a radiologist and sit in the dark for the rest of your life.” – by Stacey L. Adams
Reference:
Cush JJ. Adverse drug effects with novel agents and biologics. Presented at: Congress of Clinical Rheumatology; May 2-5, 2019; Destin, Florida.
Disclosures : Cush reports he is an investigator for AbbVie, Celgene, Genentech, Janssen and Pfizer. He also reports consultant roles with AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Horizon, Janssen, Pfizer and UCB.