鶹ý asked specialists in rheumatology around the country to tell us what they thought were the most important clinical developments in 2016. These were the five most commonly mentioned.
1. Tocilizumab (Actemra) for Giant Cell Arteritis
By far, our experts rated this the most significant advance of the year. In a plenary session at the annual meeting of the American College of Rheumatology (ACR),, of Harvard University in Boston, said "There is something new in giant cell arteritis at last, and the era of unending glucocorticoid treatment with no viable alternative is over."
This finding emerged from an international clinical trial that enrolled 250 patients. After a year of treatment, 56% of those given tocilizumab weekly plus prednisone were in sustained remission, compared with just 14% of those given placebo alone (P<0.0001).
"This trial demonstrated for the first time ever that a medication is an effective steroid-sparing therapy in this disease, which affects well over 200,000 individuals in the United States," Stone told 鶹ý. "It is the biggest breakthrough in this disease since the invention of cortisone in 1949," he noted.
2. Baricitinib for Rheumatoid Arthritis
In presentations at the ACR meeting, including a presented by, of Oxford University in England, the oral JAK1/2 inhibitor baricitinib showed greater improvements on the ACR20 response criteria at week 24 than placebo or adalimumab (74%, 37%, and 66%, respectively).
3. Anifrolumab for Systemic Lupus Erythematosus
At the annual meeting of the European League Against Rheumatism, , of Hofstra Northwell School of Medicine in Great Neck, N.Y. reported that at 1 year, 62.6% of patients receiving anifrolumab had achieved a SLE Responder Index compared with 40.2% of those given placebo (P<0.001). "These are the best lupus data we've ever seen," Furie told 鶹ý at the meeting.
4. Approval of Biosimilars
Biosimilars have now been approved for infliximab (Inflectra), etanercept (Erelzi), and , for conditions including rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, juvenile idiopathic arthritis, and ankylosing spondylitis.
5. A Crisis Unfolding
A "puts the spotlight on a coming crisis that will affect rheumatoid patients dramatically, as access to specialty care will become more difficult even in the relatively near future," commented , of the Mayo Clinic in Rochester, Minn. One reason may be that approximately half of the current rheumatology workforce is expected to retire in the next 15 years, we reported from the meeting.
"This is in the face of a growing and gaining population, for which reason demand for rheumatologic services will grow by over 130%, a mere 14 years from now. Efforts to train not only rheumatologists, but also advanced practice nurse practitioners and physician assistants in rheumatology are especially critical to ensure that rheumatology patients are properly diagnosed and managed," Matteson told 鶹ý.