Roy Fleischmann, MD: Rheumatology Winter Clinical Symposium

This week, we sat down for an interview with Roy Fleischmann, MD, to discuss his presentations for the Rheumatology Winter Clinical Symposium. Fleischmann is Clinical Professor of Medicine at the University of Texas Southwestern Medical Center at Dallas and co-Medical Director of the Metroplex Clinical Research Center in Dallas. He is presenting his findings on Combination Therapy in Rheumatology and Rheumatology 2020: A Year in Review of Novel Therapies.

When explaining the benefits of combination therapy and how he uses it in practice, Fleischmann explained, “combination therapy is superior to monotherapy with every drug that we use in rheumatoid arthritis. There are patients who can do well with monotherapy.”

“Now, patients prefer monotherapy,” he continued. “They prefer not to take methotrexate. Methotrexate does have some tolerability issues; it requires frequent lab tests... But what I do in practice is I start a patient with methotrexate…then I'll add biological targets. And then if they achieve what we both are interested in achieving, and if the patient prefers, we can try to eliminate the methotrexate. And it's really for convenience, as well as toxicity and lab testing.”

Fleischmann also discussed the new drugs that are expected to come out this year and wondered which, if any, will help a significant portion of patients and be well-tolerated, as current lupus medications tend to have a lot of toxicity.

In terms of what rheumatologists should be aware of in the upcoming year, Fleischmann focuses on the Pfizer 1133 study, an FDA-mandated safety study of tofacitinib. Results of the study indicate that the drug may slightly increase incidences of malignancy as well as major cardiovascular episodes. “We've seen a lot of literature over the years from the studies [that say] there's no increase in the latency with these drugs. And there's no increase in cardiovascular events…What this study showed was that's not true…and it raises the question as to the safety of jak inhibitors…I've been a big proponent of jaks the years. I still think the jaks are quite useful. Patients love them because they're oral, and you don't need to be injected,” he explains. “Now I'm going to have to throw into the equation... How is the patient going to respond to that versus the convenience, and maybe a little bit better efficacy than TNF inhibitors? That's something that rheumatologist have think about.”

Listen to the full interview, including a preview of his Rheumatology 2020 presentation, above.