Arthur Kavanaugh, MD: New Developments in Rheumatoid Arthritis

Rheumatology Network interviewed Arthur Kavanaugh, MD, about his Rheumatology Winter Clinical Symposium presentation, “Rheumatology 2021: Year in Review. New developments in Rheumatoid Arthritis.” Kavanaugh is currently the chairman for the 2022 conference and is Professor of Medicine and Director of the Center for Innovative Therapy at UC San Diego.

Arthur Kavanaugh, MD

Rheumatology Network: What are the new developments that in rheumatoid arthritis (RA) you'll be discussing in your upcoming presentation?

Arthur Kavanaugh, MD: In talking about rheumatoid arthritis, Dr. Jack Cush and are going to cover the early rheumatoid arthritis or early pre-rheumatoid arthritis that might develop into rheumatoid arthritis. And there have a been a couple of important updates on that. And this year, we're going to talk about sequencing and algorithmic approaches to best treat rheumatoid arthritis and some of the newer data related to that. We'll talk about the JAK inhibitors, while leaving the safety discussions to Dr. Roy Fleischmann, but about their use and what clinicians need to know. There has been an update on the biosimilars, which we still don't have very much experience at all with here in the US but tons of experience in the rest of the world.

RN: What are your thoughts on biosimilars?

AK: I have only used 2 because those are the ones that are widely available and both are intravenous, which means that the patient and the provider, are almost out of the loop in many institutions, including mine, as far as which product is chosen. And if there's ever an issue, it's hard to say I want this version rather than that version. When I hear from colleagues who've had the chance to use the subcutaneous biosimilars around the world, they seem to work well, as we would expect from the scientific information and the clinical data so far. There's no reason to think that they would be inferior. Most people around the world, in Europe and South America and Asia, they really don't have much of a choice because they're forced to use whatever is the most cost-efficient version of whatever biologic they want. However, mostly, I don't think they're unhappy with it because there seems to work like the originators.

There are several biosimilars that are already approved in the United States, but they're not available due to patent issues and other legal considerations. So, I think that is anticipated to change. I hear people saying 2023 is when we're going to see more of these. And then questions will be what is the pricing and what does that do for access? It's complicated. I care mostly about the patients and what they have access to. And the patient's care mostly about what they pay out of their pocket. There are important discussions at a much higher level about things that will influence those.

RN: Have you seen any recent trends in rheumatoid arthritis?

AK: Well, the potential treatment of early disease is a topic that’s not new, but there is new information that has come out this year that speaks to that it's always sort of made sense. It seems like a reasonable idea based on animal studies, but we haven’t really gotten there. It's still sort of an interesting consideration. You know, if you may do best if you're able to treat people very, very early with in disease, and you can probably achieve better outcomes. It’s a little tricky, though, because, of course, we've learned over the years that it's hard to predict who is really going to go on to develop rheumatoid arthritis. Some people with clinically suspected arthritis never go on to develop rheumatoid arthritis. You don't want to over treat some people while you're potentially preventing the disease in others.