Clinical Issues in Rheumatoid Arthritis: Discussions and Debates on the Evolving Roles of Targeted Synthetic DMARDs

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that can cause bone and cartilage damage and lead to disability.1 RA affects about 24.5 million people, with 5 and 50 per 100,000 people newly developing the condition each year.1,2 RA has resulted in increased mortality in recent years, creating a need for an understanding of treat-to-target recommendations and appropriate disease activity measures.3 Adopting treat-to-target strategies in RA patients has shown great promise in improving RA outcomes.4 Treatments for RA continue to emerge along with advances in the understanding of its pathologic mechanisms and the development of drugs that target them.5 Many cytokines involved in controlling cell growth and the immune response in RA function by binding to and activating cytokine receptors, which in turn rely on the Janus kinase (JAK) family of enzymes for signal transduction. Disease-modifying antirheumatic drugs (DMARDs) inhibit the activity of these JAK enzymes and block cytokine signaling.6 Identifying the mechanistic profiles and clinical trial data for current and emerging targeted synthetic DMARDs can assist health care providers in optimizing RA patient outcomes.7 In this Clinical Issues™ program, an expert faculty panel will discuss and debate the latest insights into RA immunopathology with a focus on JAK enzyme activation, increase participants’ understanding of treat-to-target recommendations and appropriate disease activity measures, and describe the mechanistic profiles and clinical trial data for current and emerging targeted synthetic DMARDs. Attendees will leave this engaging program with new information and a fresh perspective on the evolving best practices for managing patients with RA.

References:
1. Smolen JS, et al. Lancet. 2016;388(10055):2023-2038.
2. GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388 (10053): 1545-1602.
3. GBD 2013 Mortality and Causes of Death, Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;385 (9963): 117-171.
4. Bykerk VP, et al. Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice. Ann Rheum Di. 2012;71(12): 1950-1954.
5. Kahlenberg JM, Fox DA. Advances in the medical treatment of rheumatoid arthritis. Hand Clin. 2011;27(1):11-20.
6. Kontzias A, et al. Jakinibs: a new class of kinase inhibitors in cancer and autoimmune disease. Curr Opin Pharmacol. 2012;12(4):464-470.
7. Ramiro S, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017;76(6):1101-1136.