Issues in Rheumatoid Arthritis Treatment: Clinical Implications of Current Evidence
Release Date: May 2016
Expiration Date: May 31, 2017
Estimated time to complete this activity 2.66 hours
Jointly provided by:
Supported by educational grants from:
Genentech, Lilly, and Pfizer
A CME/CE Certified Online Supplement to Rheumatology News
This supplement is intended for rheumatologists, primary care physicians, nurse practitioners, nurses, physician assistants, pharmacists, and other health care providers who treat patients with rheumatic diseases.
Jonathan Kay, MD
Jeffrey Curtis, MD
With video commentary from
Gregg Silverman, MD
The faculty acknowledge the editorial assistance of Global Academy for Medical Education, LLC, and Josh Kilbridge, medical writer, in the development of this supplement.
Neither the editors of Rheumatology News nor the Editorial Advisory Board nor the reporting staff contributed to its content. The ideas and opinions expressed are those of the faculty and do not necessarily reflect the views of the of the supporters, Global Academy for Medical Education, Rutgers, or of the Publisher.
Joint Providership and Accreditation Statements
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Rutgers, The State University of New Jersey and Global Academy for Medical Education. Rutgers, The State University of New Jersey is accredited by the ACCME to provide continuing medical education for physicians.
Rutgers, The State University of New Jersey designates this enduring material for a maximum of 2.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Rutgers, The State University of New Jersey, Center for Continuing and Outreach Education (CCOE) is an approved provider of continuing nursing education by the New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider Number P173-5/31/2016.
This activity is awarded 2.66 contact hours. (60 minute CH)
Nurses should only claim those contact hours actually spent participating in the activity.
Statement of Need
In the absence of a cure for rheumatoid arthritis (RA), the goals of therapy for all patients remain reduction of signs and symptoms, prevention of radiologic progression and subsequent disability, and improved quality of life. Available therapies include TNF alpha inhibitors, the interleukin-1 receptor antagonist anakinra, the selective T cell costimulation modulator abatacept, the CD20-directed cytolytic antibody rituximab, and the interleukin-6 receptor antibody tocilizumab, and the Janus kinase inhibitor tofacitinib.
Clinicians face clinical challenges with respect to choosing appropriate treatment regimens for individual patients. Some patients fail to respond to initial treatment with a selected agent (primary treatment failure). Other patients improve initially with a treatment regimen but experience a loss of response over time. Options for patients with inadequate response to TNF inhibitors include the use of alternate TNF inhibitors, non-TNF biologics, or tofacitinib. Some of these agents may be used as monotherapy, reducing risk for side effects of methotrexate. However, clinicians should be aware of and carefully evaluate the monotherapy studies involving these agents. This educational program provides evidence-based information in an accessible format for clinicians, with the overall goals of increasing clinician’s confidence and skill in adopting newer treatment approaches including options following TNF failure and monotherapy with biologics that have mechanisms of action other than TNF inhibition.
After reading and studying this journal supplement, participants should be better able to:
- Identify the appropriate use of newer therapies for rheumatoid arthritis (RA) management based on recent trial data
- Identify all approved first-line therapy options for patients with RA
- Apply strategies for using monotherapy as an appropriate option for managing patients with RA
- Describe pharmacologic strategies for the treatment of RA as they relate to the mechanism of action of therapeutic interventions
- Discuss the potential reasons for anti–tumor necrosis factor (TNF) failure
- Describe the benefits and limitations of anti-TNF cycling in disease control and patient outcomes
- Discuss whether biologic therapies with mechanisms of action other than TNF inhibition are appropriate when managing patients in whom anti-TNF therapy has failed
- Assess approaches to managing anti-TNF cycling and switching to an agent with a different mechanism of action
- Recognize the impact of Healthcare Effectiveness Data and Information Set (HEDIS) measures and Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System on reimbursement for management of patients 18 years and older who were diagnosed with RA
Method of Participation
Participants should read the activity information, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a webpage that will allow you to receive your certificate of credit via email or you may print it out at that time.
Inquiries may be directed to Global Academy for Medical Education firstname.lastname@example.org or (973) 290-8225.
Individuals in a position to control the content of this educational activity are required to disclose: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.
Jeffrey Curtis, MD
Dr. Curtis has received grant research support from: AbbVie Inc., Amgen Inc., Bristol-Myers Squibb Company, Crescendo Bioscience, Inc., Corrona, LLC, Genentech, Inc., Ortho-McNeil-Janssen Pharmaceuticals, Inc., Pfizer Inc., and UCB, Inc. He has also been a consultant for: AbbVie, Amgen, Bristol-Myers Squibb, Crescendo, Corrona, Ortho-McNeil-Janssen, Pfizer, and UCB
Jonathan Kay, MD
has received grant research support from: AbbVie, Eli Lilly and Company, F. Hoffmann-La Roche Ltd, and Pfizer. He has also been a consultant for: AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim GmbH, Bristol-Myers Squibb, Crescendo, Eli Lilly, EPIRUS Biopharmaceuticals, Inc., Genentech, GlaxoSmithKline PLC., Hospira, Inc., Janssen Biotech, Inc., Merck Sharp & Dohme Corp., Nippon Kayaku Co., Ltd., Novartis Pharmaceuticals Corporation, Pfizer, Samsung Bioepis Co., Ltd., and UCB.
In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, CCOE has resolved all potential and real conflicts of interest through content review by a non-conflicted, qualified reviewer. This activity was peer-reviewed for relevance, accuracy of content, and balance of presentation by: Ashraf Raslan, MD – Rheumatology Fellow, Rutgers Robert Wood Johnson Medical School, Department of Medicine, New Brunswick, NJ; and Stacy Johnson, RN – Nurse, Rutgers Robert Wood Johnson Medical School, Department of Dermatology, New Brunswick, NJ. They have no relevant financial relationships to disclose.
Field Testers: This activity was pilot-tested for time required by: Physicians: Daniel Grabell, MD , Shreya Patel, MD , and Cliff Stermer, MD. Nurses: Geraldine Bocchieri, BSN, RN ; Rosalind Julius Mickel, MSN, RN ; and Carol Ruland, RN . The field testers have no relevant financial relationships to disclose.
Rutgers, The State University of New Jersey: Tristan Nelsen, MNM, CMP, and Elizabeth Ward, MSJ, have no relevant financial relationships to disclose.
Global Academy for Medical Education Staff: Sylvia H. Reitman, MBA, DipEd; Shirley V. Jones, MBA ; Mike LoPresti; and Josh Kilbridge have no relevant financial relationships to disclose.
Off-Label/Investigational Use Disclosure
This CME/CE activity does not contain information on commercial products/devices that are unlabeled for use or investigational uses of products not yet approved.
Contact Information for Technical Questions
Please technical questions or concerns to Global Academy for Medical Education at 973-290-8225 or email email@example.com.
This continuing medical education (CME/CE) supplement was developed from interviews with the Faculty. It is the final activity in the three-part curriculum, Advancing the Management of Rheumatoid Arthritis: Applying Evidence-Based Strategies to Improve Patient Outcomes. The supplement content brings together the key teaching points from the previous two online activities, which may be found at: http://tinyurl.com/AdvanceRA.
The Faculty acknowledge the editorial assistance of Global Academy for Medical Education, LLC, and Josh Kilbridge, medical writer, in the development of this supplement. This activity was developed under the direction of the Faculty, Global Academy for Medical Education, and Rutgers. Neither the editors of Rheumatology News nor the Editorial Advisory Board nor the reporting staff contributed to its content. The ideas and opinions expressed in this supplement are those of the Faculty and do not necessarily reflect the views of the supporters, Global Academy for Medical Education, Rutgers, or the Publisher.
Copyright © 2016 by Global Academy for Medical Education, LLC and Rutgers, The State University of New Jersey. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of Global Academy for Medical Education and Rutgers. Global Academy for Medical Education and Rutgers will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein.