‘Improve new drug access to treat rheumatoid arthritis'

to fundamentally treat the disease, not just its symptoms

Sung Chul Shim, Professor of Rheumatology, Chungnam National University Hospital

Need for treatment rises to prevent joint damage, not just symptom control

Several JAK inhibitors have emerged switching is not allowed..."We need to broaden our options”

Dr.Sung Chul Shim, Professor of Rheumatology, Chungnam National University Hospital

“Rheumatoid arthritis is not just a painful disease, but a disease that can cause direct damage to the joints.

 

Patients need to start treatment with good treatments in a timely manner, but their access to new drugs is still limited.

 

Switching between JAK inhibitors should be allowed freely so patients can receive personalized treatment.” Sung Chul Shim, Professor of Rheumatology at Chungnam National University Hospital, evaluated the current treatment landscape for rheumatoid arthritis as so during a recent interview with Dailypharm.

 

Rheumatoid arthritis is a disease in which the synovial membrane becomes inflamed due to immune dysfunction.

 

The disease initially starts with tingling and pain in the hands, but if left untreated, joint deformities can occur, accompanied by anemia, dryness, subcutaneous rheumatoid nodules, and pulmonary fibrosis.

 

“People with rheumatoid arthritis don't realize that their joints are being damaged,” said Professor Shim.

 

“They are often reluctant to start treatment early because they believe that taking pain medications is enough to relieve their symptoms.” “However, the molecules that cause pain are not the same molecules that are involved in joint damage.

 

If you control the molecules that are involved in pain, such as prostaglandins, you can reduce the pain, but if you don't target the molecules that are involved in joint damage, your joints may continue to be damaged.”  Professor Shim noted how rheumatoid arthritis has a poor early diagnosis rate.

 

The golden time to treat rheumatoid arthritis is 2 years, and if treatment is not started within this period, joint deformity will begin, which is why early diagnosis and aggressive treatment are important.

 

“The lack of early diagnosis in rheumatoid arthritis is due to low patient awareness,” said Professor Shim.

 

If they recognize rheumatoid arthritis as a disease that destroys joints, they will start treatment sooner, but if they recognize it as just a painful disease, they will postpone treatment.”  Multiple rheumatoid arthritis treatment options available...switching between drugs should be considered" The good news is that there are many treatment options available for the disease.

 

From steroids to anti-rheumatic drugs to biologics to Janus kinase (JAK) inhibitors, there is a wide range of options available for prescriptions.

 

“There are more treatments for rheumatoid arthritis than for any other disease, including oral and injectable medications,” says Dr.

 

Shim, ”Yet as many as 10% of patients do not respond to the currently available treatment options.  As such, having more treatment options doesn't necessarily mean they will work for everyone.

 

Timely access to the right treatment requires an accurate diagnosis and a specialist who can switch medications at the right time for patients who have developed resistance.

 

Currently, four JAK inhibitors are available, including Jyseleca, Xeljanz, Rinvoq, and Olumiant, but they cannot be switched between JAK inhibitors once started.

 

Also, they cannot be switched to a biologic drug either.

 

This is why the patients’ choices are limited despite the many treatment options available.

 

In September, health authorities were expected to announce an amendment that allows switching between JAK inhibitors in rheumatoid arthritis but postponed it.

 

The authorities are now expected to issue the amendment in December.  “At this point, even with other therapies available for the same indications, we cannot use them,” said Professor Shim.

 

There are patients who don't respond to one treatment, so we need to switch between drugs.

 

There's no reason to keep them on the same drug when they're getting worse with it.” He added, “The goal of rheumatoid arthritis treatment should be to protect the joints, not control pain.

 

For this, we need to be able to use the various treatment options available to us.

 

It seems that governments are hesitant to allow switching because of the immediate budget impact.

 

If the disease worsens and patients have to undergo surgery, this will be more costly in the long run.”