Peter C Taylor, PhD: Complexities of Treatment and Unmet Needs in Rheumatoid Arthritis

Peter C Taylor, PhD, Norman Collisson professor of Musculoskeletal Sciences, University of Oxford, sat down with HCPLive to discuss the current treatment landscape in rheumatoid arthritis (RA) and the unmet needs of this patient population.

When treating patients with RA international guidelines usually recommend starting with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). However, if a patient does not respond adequately to these medications, the standard practice is to consider targeted therapies. Taylor mentioned the significant expansion in recent years of highly effective targeted therapies for this patient population. These include biologics targeting tumor necrosis factor (TNF), cytokines, and B cells, followed by the recent approval of small molecules like Janus kinase (JAK) inhibitors.

However, despite this growth and the better outcomes achievable today, numerous unmet needs in the treatment of this condition remain.

Taylor explained a generation ago, the outlook for rheumatoid arthritis was bleak. The disease often led to severe joint damage and loss of function over time.

“When I started out in this specialty, unfortunately, our outpatient clinics were full of individuals who were really struggling and often wheelchair bound and with very marked disability,” he stated. “If we were to fast forward to the contemporary era, where we have this large range of efficacious therapies, there's a marked difference, because nowadays, patients who are people living with rheumatoid arthritis may be like any one of the rest of us in appearance. But nonetheless, they have many different symptoms that will often only be known for themselves."

Although contemporary treatment aims for remission or low disease activity, a notable proportion of patients cannot achieve or sustain remission. Even for those in remission, they may experience pain, fatigue, and other subjective yet debilitating symptoms.

This subjective aspect constitutes a significant unmet need, particularly in terms of its impact on individuals' lives. Pain and fatigue exemplify this aspect vividly. For some, there is also a gradual loss of function over time

Another major unmet need today stems from the treatment paradigm itself. The approach often involves cycling through various targeted therapies with the goal of reaching remission or low disease activity. However, a significant minority of patients never reach these goals.

“On the one hand, it's true to say that the outlook for people who present with rheumatoid arthritis is better than it has ever been,” Taylor concluded. “But on the other hand, the nature of unmet need has shifted somewhat away from the more physical and disability components that dominated over a generation ago, and more towards the subjective components of disease, such as pain, fatigue, and other related problems.