Participating Faculty: Improving Clinical and Managed Care Outcomes in Rheumatoid Arthritis: New Guidelines, Therapies, and Challenges [CPE]

This supplement to The American Journal of Managed Care is intended to provide an understanding of the pathophysiology, symptoms, and management of rheumatoid arthritis (RA). Included is the most recent classification criteria used in diagnosis and in clinical guideline recommendations. This supplement also provides an overview of the current therapeutic options in RA, with a focus on the role of disease-modifying antirheumatic drugs. The economic impact and managed care implications associated with managing RA and its common comorbities is also discussed.Release date: May 21, 2014 | Expiration date: May 21, 2016

Estimated time to complete activity: 2.5 hours

Type of Activity: Knowledge | Activity fee: Free of charge

Medium: Print with Internet-based posttest, evaluation, and request for credit.

This activity is supported by educational grants from Antares Pharma, Inc.

Intended Audience

Managed care professionals, pharmacists, and specialty pharmacists.

Statement of Educational Need

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, affecting approximately 1% of the worldwide population. RA is characterized by polyarticular synovial inflammation of the small joints of the hands and feet and production of autoimmune antigens that initially result in joint swelling, stiffness, and tenderness. In the absence of effective treatment, RA eventually results in destruction of both the cartilaginous and bony elements of the joint, with resultant disability. RA also results in ongoing systemic inflammation that is associated with comorbidities, particularly increased cardiovascular disease, which contributes to morbidity and mortality. In addition to the pain, disability, and work limitation resulting from joint damage, the burden of RA includes psychosocial deficits, fatigue, cognitive impairment, and reduction in health-related quality of life.

Over the past 20 years, the management of RA has been transformed from mere alleviation of symptoms with analgesics and corticosteroids to disease control with the introduction of effective biologic disease-modifying antirheumatic drugs (DMARDs) and new treatment paradigms such as early, treat-to-target management. In particular, the early use of traditional DMARDs (eg, methotrexate) in combination with biologic DMARDs directed against tumor necrosis factor and other mediators of inflammation, have helped to reduce disease progression to joint damage and to make disease remission a reasonable goal of RA management. Treatment recommendations that define therapeutic options based on patient characteristics and duration of disease have been promulgated recently by the American College of Rheumatology. Similarly, a recent report by the Agency for Healthcare Quality and Research summarized evidence on the comparative safety and efficacy of the drugs used to treat RA. Rheumatologists must be aware of emerging research such as this, which can affect both the choice and the timing of agents to be used in a particular patient with RA.

Educational Objectives

Upon completion of the educational activity, the participant should be able to:

• Assess the epidemiology, burden, and pathophysiology of disease related to RA and the importance of early intervention to delay disease progression
• Distinguish and compare standard, new, and emerging agents for the treatment of RA, including biologic therapies, and on new uses, administration rates, or formulations of previously approved agents
• Delineate the optimal role of the managed care provider and use of disease therapy management programs in optimizing patient care

Disclosure Policy

According to the disclosure policies of Pharmacy Times Office of Continuing Professional Education and The American Journal of Managed Care, all persons who are in a position to control content are required to disclose any relevant financial relationships with commercial interests. If a conflict is identified, it is the responsibility of the Pharmacy Times Office of Continuing Professional Education to initiate a mechanism to resolve the conflict(s). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

Accreditation and Credit Designation

Pharmacy Times Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 2.5 contact hours (.25 CEUs) under the ACPE universal activity number 0290-0000-14-047- H01-P. The activity is available for CE credit through May 21, 2016.

Obtaining Credit:

Participants must read each article in this supplement and proceed to www.ajmc.com/ce or www. PharmacyTimes.org to complete the online posttest, achieving a passing score of 70% or higher, complete an online evaluation, and then request their statement of credit.

Faculty

Allan Gibofsky, MD, JD, FACP, FCLM

Professor of Medicine and Public Health

Weill Medical College of Cornell University

New York, New York

Attending Rheumatologist

Hospital for Special Surgery

New York, New York

Gary M. Owens, MD

President

Gary Owens Associates

Ocean View, Delaware

Contributing Editorial Support

Joseph Melton, PhD

Medical Writer

Melton Medical Communication

Kendall Park, New Jersey

Elizabeth Paczolt, MD, FACNM

Medical Consultant

Churchville, Pennsylvania

Faculty Disclosures

These faculty have disclosed the following relevant commercial financial relationships or affiliations in the past 12 months.

Allan Gibofsky, MD, JD, FACP, FCLM

Consultant or paid advisory board: AbbVie, Amgen, Antares Pharma, Inc, Celgene, Iroko, and Pfizer

Speaker’s bureau: AbbVie, Amgen, Antares Pharma, Inc, Celgene, Pfizer, and UCB

Stock/shareholder: AbbVie, Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Johnson & Johnson, Pfizer, and Regeneron

Gary M. Owens, MD

Consultant: AbbVie, Crescendo Bioscience, and Johnson & Johnson

Joseph Melton, PhD

Stock/shareholder: Johnson & Johnson

Elizabeth Paczolt, MD, FACNM, has no relevant financial relationships with commercial interests to disclose.

The American Journal of Managed Care

Publishing Staff—Jeff D. Prescott, PharmD, RPh; Ida Delmendo; and Tara Petersen have disclosed no relevant financial relationships with commercial interests.

Pharmacy Times Office of Continuing Professional Education Physicians’ Education Resource®, LLC

Planning staff—David Heckard; Mary Jo Dixon, RPh; Donna Fausak; and Nathalie Harden have no relevant financial relationships with commercial interests to disclose.

Off-label Disclosure and Disclaimer

The contents of this CME/CE supplement may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians and pharmacists should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information

for these products.

For additional information about approved uses, including approved indications, contraindications, and warnings, participants are advised to consult prescribing information for all products discussed. The information provided in this CME/CE activity is for continuing medical and pharmacy education purposes only and is not meant to substitute for the independent medical or pharmacy judgment of a physician or pharmacist relative to diagnostic, treatment, or management options for a specific patient’s medical condition.

The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of The American Journal of Managed Care, Physicians’ Education Resource® , LLC, the Pharmacy Times Office of Continuing Professional Education, or any of the companies that provided commercial support for this CME/CE activity.

Signed disclosures are on file at the office of The American Journal of Managed Care, Plainsboro, New Jersey.

Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, the editorial staff, or any member of the editorial advisory board. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, is not responsible for accuracy of dosages given in articles printed herein. The appearance of advertisements in this publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.