VIDEO: Recent advancements in rheumatoid arthritis

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I think it's a very exciting time in rheumatoid arthritis because we're learning so much more, not only about the biology of rheumatoid arthritis but also what else can we do therapeutically for it. I think there have been several studies now that have focused on delaying or, if you will, preventing the classification of inflammatory arthritis as rheumatoid arthritis. There were a couple of studies early on. One was rituximab. That is a anti B cell molecule that showed delayed classification of rheumatoid arthritis in patients who were randomized to that medication compared to the control group. However, there have been studies with methotrexate, and with hydroxychloroquine, particularly methotrexate, which is like a workhorse for treatment of inflammatory arthritis; for either of these medications, we haven't seen any delayed or prevention of classification of a patient's symptoms as rheumatoid arthritis.

There's a molecule called abatacept (Orencia, Bristol-Myers Squibb) that works by affecting T cells, and there were two studies that were published earlier this year that showed that administration of abatacept was able to delay the progression to rheumatoid arthritis in patients that were randomized to this group. So that's very exciting because that provides some hope for people that may have inflammatory arthritis, but not yet what we define as rheumatoid arthritis in trying to delay the onset of actual rheumatoid arthritis. Another interesting development recently has been looking at the association between anti-drug antibodies and loss of response to certain medications. And we've known for a while that anti-drug antibodies occur in patients that are taking medications such as infliximab (Remicade, Janssen), or adalimumab, or rituximab. But what this cohort study called the ABRA Cohort Study showed is that anti-drug antibodies also occur in patients that are taking tocilizumab, which is an IL-6 blocking molecule and to a lower extent in patients that take an anti-TNF molecule called etanercept (Enbrel, Amgen). The other important piece of this study was that indeed these anti-drug antibodies are associated with a non-response to biologic drugs in rheumatoid arthritis.

Other exciting events, or discoveries, if you will, in rheumatoid arthritis have been trying to look at novel approaches to treat rheumatoid arthritis. One such approach is auricular vagus nerve stimulation that sort of held the promise that not taking a medication, but just having a stimulation of the auricular branch of the vagus nerve could help treat rheumatoid arthritis. There were several open label studies that looked really promising in terms of the response. People that were having their auricular branch of the vagus nerve stimulated would have a better response for their rheumatoid arthritis disease activity; it would decrease disease activity in rheumatoid arthritis. However, in a rigorous done study that was randomized, double-blind, and SHEM controlled in patients with active rheumatoid arthritis who have failed conventional synthetic disease modifying agents and were naive to biologics did not have expected result. There was no difference between the active arm. So the people in the group that had their auricular vagus nerve stimulation done in terms of disease activity compared to the group that were in the SHEM control arm of the study, that's disappointing, but perhaps other modalities of vagus nerve stimulation in the future may result in a different more positive finding.

And then, one other topic I wanted to mention because we hear a lot about it in clinic, especially now as many more biosimilars are coming on the market, is trying to answer the question whether or not taking a biosimilar is as effective as taking the originator, biological inpatient with rheumatoid arthritis. And while we had quite a few studies that were done on this topic, a systematic review of the result on several randomized controlled trials are put together had not been performed until recently.

And then, there was a recently published systematic review that included over 10,000 patients that were on biosimilars for adalimumab, infliximab, and etanercept, and had been part of about 25 studies. And what the systematic review and meta-analysis concluded is that both disease activity and functional status were equivalent in people that took the biosimilar versus those that took the originator biological molecule. So that's really exciting because now we have additional information to provide to our patients that are concerned very understandably when they have to switch to a biosimilar molecule. Another thing I want to say about biosimilars is that, in this systematic review, biosimilars were associated with similar safety profile and also immunogenicity profile compared to reference biologic drugs; so more good news on that.