Janet Pope, MD: Need For Cost-Effective Treatments in Rheumatology


Janet Pope, MD, professor of medicine at the University of Toronto, discusses whether she believes clinicians will ever transition away from DMARDs and biologics due to the high cost and what the alternatives are for those patients.

Since their introduction, disease-modifying antirheumatic drugs (DMARDs) and biologics have dominated research and discussion in the field of rheumatology.

Yet as the data attesting to their efficacy and safety grows, the price of these treatments means they are not an option for some patients.

At the Clinical Congress of Rheumatology (CCR) West 2019 annual meeting in San Diego, CA, the clinical effectiveness of DMARDs and biologics in various patient populations was a common topic of discussion, but some of the information presented at the conference was oriented around more cost-effective options—including one examining low-dose prednisone for inducing remission in newly diagnosed rheumatoid arthritis patients.

After judging the poster session and presenting during a symposium on immunology, Janet Pope, MD, professor of medicine at the University of Toronto, had a unique perspective on the breadth of information presented at this year’s conference. During her interview with MD Magazine®, Pope covered topics including from day one highlights and areas in need of greater research.

In the same interview, Pope gave her thoughts on whether we will start to see a shift away from DMARDs and biologics and to a more cost-effective alternative. 

MD Mag: Do you think we will see rheumatologists shift away from DMARDs and biologics for more cost-effective alternatives?

Pope: So that's a really tough question—there is an emphasis still on most of our diseases we are trying to treat-to-target, especially inflammatory arthritis diseases, but even a target of low disease state and vasculitis and things and to get there it's often combinations. Often using our regular medications and then adding in advanced therapies.

I think what I would like to see and we'd all like to see is costs coming down. I think we still have in most diseases that I treat some patients where nothing works when you follow the guidelines and we think they're taking the meds. It's not working because they're not taking them—they're taking the meds and I do think we have to target research on what's different about them and how do we use the drugs we already have but in different combinations, with proven combinations.

Where we have to really say “Let's do trials in the worst patients," because they're about 15% of any group of patients we treat and think about combining things we wouldn't traditionally combine to say can we help them because otherwise they cost the system a lot of money too.

I think, as well, biosimilars aren't very adopted in the US and I think they're really important, in my opinion, for cost containment because it's like almost BOGO—buy one, get one. So, if it costs half price you could treat 2 people for the cost of 1. If it was two-thirds cost, you could treat 3 people for the cost of 2.

So, I think that in order to have innovation and access for more people and allowing other drugs to come on to formularies, we have to really look more rationally at the cost of drugs and where all things are equal the lower base cost might be the one that will be reimbursed in the future.

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