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Evolving Treatment Options in Rheumatoid Arthritis: ACR’s New RA Treatment Guidelines and the Role of JAK Inhibitors

Evolving Treatment Options in Rheumatoid Arthritis: ACR’s New RA Treatment Guidelines and the Role of JAK Inhibitors

PDF Publication
Released: 1/29/2021
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Expires: 1/28/2022
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Max Credits: 0.75
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Faculty
Seema Q. Frosh, MD
Assistant Professor of Rheumatology
University of Central Florida
Staff Rheumatologist
Orlando Veterans Affairs Medical Center
Orlando, FL

Gail S. Kerr, MD, FRCP(Edin), FACR, FACP
Chief of Rheumatology
DC Veterans Affairs Medical Center and Howard University Hospital
Professor of Medicine
Georgetown University and Howard University
Washington, DC
 
Activity Planners
Lisa Hack
Manager, Education Strategy and Content
Med-IQ
Baltimore, MD

Jane Frutchey, MS
Managing Editor
Med-IQ
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Med-IQ
Baltimore, MD

Amy Sison
Director of CME
Med-IQ
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM
Associate Director, Education Quality and Compliance
Med-IQ
East Lansing, MI

Writer
Katherine Kahn
Holyoke, MA
  
Learning Objectives
Upon completion, participants should be able to:

  • Describe key differences among JAKis that are currently available or in late-stage clinical testing for the treatment of RA
  • Apply available evidence regarding the efficacy of JAKis to current and future treatment decisions for veterans with RA
  • Adopt strategies to mitigate potential adverse events among veterans with RA for whom treatment with a JAKi is being considered

Target Audience
This activity is intended for physicians, nurses, pharmacists, and other providers who manage the health of approximately 18 million beneficiaries in the federal healthcare system, including the Veterans Health Administration and the military through all branches of service in the Department of Defense.
 
Statement of Need
Despite a broad selection of treatments for rheumatoid arthritis (RA), most patients do not experience a complete response that can be sustained over the long term with currently available therapies. An active research pipeline of agents with varying levels of selectivity against specific isoforms in the Janus kinase (JAK) family is beginning to bear fruit, with several recent and anticipated future approvals. However, the emergence of new agents in this class creates an immediate practice gap for rheumatology clinicians practicing in the federal healthcare system who are involved in the care of veterans with RA, as there are differences among individual agents and important safety considerations that must be addressed as more therapies become available for use in the clinic.

Providership Statement
Provided by Med-IQ. 
 
Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
 
Med-IQ designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Med-IQ is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This nursing activity has been approved for up to 0.75 contact hour.

ACPEMed-IQ is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.75 contact hour (0.075 CEU) of credit for pharmacists. ACPE #0476-0000-21-001-H01-P. This knowledge-based activity is designed for all pharmacists.

MIPSCompletion of this accredited CME?activity meets the expectations of an Accredited Safety or Quality Improvement Program (IA_PSPA_28) for the Merit-based Incentive Payment Program (MIPS).

Physician assistants and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Medium/Method of Participation
This CME/CE activity consists of a 0.75-credit online publication. To receive credit, read the introductory CME/CE material, read the publication, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly. Pharmacists will have credits uploaded directly to NABP.

Initial Release Date: January 29, 2021
Expiration Date: January 28, 2022
Estimated Time to Complete This Activity: 45 minutes

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Seema Q. Frosh, MD, has indicated no real or apparent conflicts.

Gail S. Kerr, MD, FRCP(Edin), FACR, FACP
Consulting fees/advisory boards: Horizon Therapeutics plc, Janssen Pharmaceuticals, Inc., Sanofi Genzyme, UCB, Inc., Viela Bio
Fees received for promotional/non-CME activities: Aurinia Pharmaceuticals Inc.
Contracted research: Bristol Myers-Squibb, Genentech, Gilead Sciences, Inc., MedImmune, Pfizer, Inc., Novartis Pharmaceuticals Corporation

The writer, peer reviewers, and activity planners have no financial relationships to disclose.
 
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
 
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.
 
Contact Information
For CME/CE questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email info@med-iq.com.

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Disclaimer
The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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This activity is available free of charge to participants.

Acknowledgment of Commercial Support
This activity is supported by an educational grant from AbbVie, Inc.
 
Copyright
© 2021 Med-IQ, Inc.

Abstract

Here are some key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available by clicking the "Continue" button below.

  • RA, which is primarily characterized by joint inflammation, is a systemic disease that has a profound impact on health-related quality of life and increased mortality risk
  • The VHA serves an estimated 67,000 veterans with RA, a population with a high prevalence of both risk factors for the development of RA (eg, cigarette smoking) and of comorbid conditions (eg, hypertension, CVD, diabetes) that may complicate RA management
  • An analysis of data from VARA found that male veterans enrolled in the registry had a more than 2-fold increase in mortality risk compared with age-matched men without RA in the general US population
  • A recent analysis of DMARD treatment patterns in US veterans found that approximately 31% of veterans with RA do not receive DMARDs during the first 12 months of diagnosis, despite ACR RA guideline recommendations for their prompt initiation following diagnosis
  • JAKis, orally administered tsDMARDs that inhibit the JAK family of kinases, have been developed as treatments for autoimmune diseases, including RA
  • At the 2020 ACR Convergence virtual annual meeting, proposed updates to guidelines for the treatment of RA were presented, which included greater latitude in choice of bDMARDs and tsDMARDs at different levels of RA disease activity
  • Based on proposed updates to the ACR guidelines, JAKis may now be considered reasonable alternatives to TNFis and other bDMARDs in patients with moderate to severe disease, and are a viable choice in patients who are inadequate responders to MTX or bDMARDs

View reference list.

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Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.