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

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Expiring Soon
Released: 1/29/2021
Expires: 1/28/2022
Max Credits: 0.75
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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
Baltimore, MD

Jane Frutchey, MS
Managing Editor
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

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

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.

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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

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


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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