acr 2018

ACR 2018 Sessions Include Drug Pricing, OA Treatments, Diet as Therapy

The American College of Rheumatology (ACR) reports there were currently 15,000 attendees representing 106 countries at the 2018 Annual Meeting in Chicago and more than 3,000 abstracts on exhibit. Also on tap: session after session highlighting the newest research and filling in information gaps, and the Arthritis Foundation’s Patient Reps are hard at work going to them and reporting back with their findings and impressions.   

Donna Dernier attended a session called “Mechanics of PBMs and Patient Access to Medications.” PBMs, which stands for Pharmacy Benefit Managers, are the groups that work between drug manufacturers and health insurance plans that decide which drugs are in the plans’ formulary, how much they will cost and who will have access. “They are totally opaque, powerful, they use a system of rebates and fees to set the prices. They are largely unregulated,” says Dernier. Thanks to long, complicated forms that medical practices have to fill out, “Lots of practices cannot handle that workload and their patients lose out,” she says.  

The Daltroy Memorial Lecture examined “What Matters In Patient-Provider Relationships? Values, Attitudes & Beliefs.” Gary Davenport reports, “This talk brought to light the importance of physicians and patients understanding how history, life experiences and perspectives, race, culture, ethnicity and family history factor into the quality of patient-provider relationships. 

“[It] defined ‘implicit biases,’ which we all have, and examples were given on how they negatively affect patient-provider relationships,” he says. “The main takeaway for me from this session was the fact that physicians must take an unbiased approach and sincerely look at the patient’s overall life factors to accomplish the absolute best care of those that they treat. Anything less is not quality health care.” 

Rick Phillips attended one of the many sessions on the diagnosis, assessment, prognosis, outcomes and comorbidities of rheumatoid arthritis (RA). Among the abstracts presented was one on a biosimilar to adalimumab (called GP2017) used to treat psoriatic arthritis. Patients were randomized to receive either adalimumab (Humira) or the adalimumab biosimilar (GP2017). If at the end of 14 weeks the patients in the Humira group showed improvement to the medication, they were switched to the adalimumab biosimilar and were followed for 32 additional weeks, while the patients on GP2017 stayed on their drug through the entire study. 

At the end of the study, “the two groups are almost mirror images of each other,” says Phillips, meaning that “patients were able to switch between adalimumab to adalimumab biosimilar with no reduction in treatment outcomes.”    

Phillips also attended a session called “Health Services Research I: Focus on Big Data” that examined how Big Data is collected and can be harnessed and put to good use. “The big data session extensively used RISE information to compare the care of large populations,” explains Phillips. “The takeaway in my opinion is that feeding these databases will, over time, make care better, outcomes more predictable and treatment quicker. The presenters gave us a great flavor of the types of data available and the variety of uses that have been done so far.”     

The session “Emerging Treatments for OA: Targeting Pain vs Structure” looked at the medications in the pipeline to treat osteoarthritis (OA) and asked the question, “Should we be targeting improving pain or improving the structure of the joint?” There are seven disease modifying osteoarthritis drugs in the pipeline, in various stages of study.  

In the lecture on Diet as Therapy: Lessons from IBD,” James Lewis, MD, professor of medicine and epidemiology at the University of Pennsylvania discussed the lessons learned from inflammatory bowel disease (IBD). Will they work for autoimmune, inflammatory types of arthritis like juvenile arthritis (JA) and RA? There are no good data but there are clues that some might. Bottom line, for now: Fresh (not processed) ingredients and home-cooked meals are the best course. Why is it so hard to tease out what is good or bad to eat? Dr. Lewis says it’s because we don’t understand how diet works to be an effective intervention, while drugs are now designer molecules developed with a specific target in mind. 

Finally, an excellent session on “Sexual Health, Intimacy and the Effects of Rheumatic Diseases” explored how rheumatic conditions adversely affect sex life. Nurse educator Elaine Furst says the list of ways is long but she offered many options to overcome barriers.  

And lastly, three new draft guidelines were unveiled. Dr. Lisa Sammaritano at the Hospital for Special Surgery-Weill Cornell Medical Center discussed ACR’s first guideline on “Reproductive Health in Rheumatic Diseases,” which includes advice on contraception, pregnancy and menopause. Dr. John Stone from Harvard Medical School and Massachusetts General Hospital presented a draft of the ACR/EULAR Classification Criteria for IgG4-Related Disease. IgG4-RD is a newly-discovered disease that may affect different organ systems and often mimics other diseases. And Dr. Peter Merkel from the University of Pennsylvania and Harvard Medical School presented drafts of two updated classification criteria, one for Giant Cell Arteritis and the other for Takayasu’s Arteritis, the two major categories of large-vessel vasculitis. 

Author: Andrea Kane for the Arthritis Foundation.

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