Trends and Predictions for Rheumatology in 2024, with Angus Worthing, MD

In an interview with HCPLive, Angus Worthing, MD, discusses the recent developments in rheumatology and his predictions for the future of treatment moving into 2024 and beyond.

Over the past few years, there have been new drug approvals for diseases like systemic lupus, spinal arthritis, and psoriatic arthritis. However, frustration arises when these drugs are inaccessible to patients. In 2024, Worthing hopes more people will be able to access medications with the introduction of biosimilars and reforms in the drug distribution system at the federal and state levels.

Although monitoring patient-reported outcomes is not within his regular scope, he uses daily patient global scores to assess autoimmune arthritis. Patient-reported outcomes are crucial for understanding treatment goals and developing effective strategies. While not a recent breakthrough, since 2010, the US Food and Drug Administration (FDA) pathway for biosimilars has aimed to reduce the cost of biologic therapy for rheumatology patients. The use of self-injectable biosimilars is increasing, potentially improving access and reducing barriers in 2024.

Worthing emphasized understanding patient goals for autoimmune disease treatment is increasingly important, and a treat-to-target approach helps achieve those goals. Despite FDA-approved treatments, predicting which drug is best for an individual remains a challenge. Excitingly, modifying the immune system through therapies like CAR-T therapy holds promise for achieving medication-free remission.

Concerning drug industry middlemen, pharmacy benefit managers (PBMs) have silently influenced medication choices. The PBM auction system, rewarding higher-priced drugs with rebates, impacts step therapy protocols. Worthing encourages patients to learn about this system and advocate for change to their rheumatologists, elected officials, and at the state level. Luckily, reforms at the state level and ongoing investigations by the Federal Trade Commission offer hope for improvements in 2024.

Worthing is a rheumatologist in private practice in the DC metropolitan area and an advocate working to reform the healthcare system as a leader in the Alliance for Transparent & Affordable Prescriptions (ATAP) Action Network, a nonprofit organization dedicated to increasing transparency and improving access for patients to medications and specifically reforming pharmacy benefit managers. He has no relevant disclosures to report.