"Reimb granted to drug switching between JAK inhibitors"

Dr. Seung-Jae Hong, Professor in the Department of Rheumatology at Kyung Hee University Medical Center

Drug switching between JAK inhibitors will be reimbursed in December…"The treatment landscape for rheumatoid arthritis is expected to be improved"

"Patients have a variety of treatment options to choose from…supportive policies are needed"

Dr.

 

Seung-Jae Hong, a Professor in the Department of Rheumatology at Kyung Hee University Medical Center

"Until now, drug switching between JAK inhibitors has not been reimbursed, so there have been unmet patient needs for rheumatoid arthritis patients who do not benefit from conventional biological agents.

 

As reimbursement for drug switching will be granted starting in December, patients will be less burdened by switching from biological agents to JAK inhibitors.

 

Also, patients will no longer resort to treatments they do not benefit from.

 

The reimbursement approval will significantly change the treatment landscape for rheumatoid arthritis." Dr.

 

Seung-Jae Hong, a Professor in the Department of Rheumatology at Kyung Hee University Medical Center, remarked on changes to the treatment landscape for rheumatoid arthritis during a recent meeting with Daily Pharm.

 

Rheumatoid arthritis treatments are one of the fields that accomplished the most advances in the past 20 years.

 

Treatment options for patients have broadened after the introduction of steroids, anti-rheumatic drugs, biological agents, and Janus Kinase (JAK) inhibitors.

 

Since drug switching was not approved for reimbursement, patients required to switch from biological agents to JAK inhibitors had to revert to biological agents if the switch was ineffective.

 

As patients and doctors demanded drug switching, the government granted approval of insurance reimbursement for drug switching between JAK inhibitors; starting in December, patients will be less burdened by switching from biological agents to JAP inhibitors.

 

"At the early stage, nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to suppress inflammation and reduce pain.

 

Steroids can then be temporarily used if inflammation is not controlled.

 

However, such a treatment regimen can reduce the alleviation of symptoms but does not lower disease activation.

 

As a result, treatments using disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), may be necessary," Dr.

 

Hong said.

 

"If sufficient treatment effects are not observed within several months, targeted treatments such as biological agents or JAK inhibitors can be used.

 

Such targeted treatment works by suppressing substances that induce inflammation in rheumatoid arthritis or targeting the signaling pathways of inflammatory substances.

 

The targeted treatments can reduce side effects, while high treatment effects can be expected.

 

This is why switching medications is necessary for treating rheumatoid arthritis," Dr.

 

Hong said.

 

Rheumatoid arthritis is an autoimmune disease caused by immune cells attacking the joints, which are part of our own body.

 

At the early stage of the disease, inflammation occurs in the tissue lining of joints, causing pain, swelling, and deformities in surrounding bones and cartilage.

 

Inflammation primarily affects small joints such as the fingers, wrists, toes, and ankles but can also involve larger joints like the knees.

 

As a chronic disease that progresses over months or years, persistent inflammation of the tissue lining of joints can lead to cartilage damage, causing joint destruction, deformation, and functional disability.

 

Symptoms such as fatigue, low-grade fever, and generalized musculoskeletal pain are often accompanied.

 

However, among patients treated with biological agents, only 56.5% achieve remission or a low disease activity state within the first year of treatment.

 

Furthermore, 43.5% of rheumatoid arthritis patients treated with existing therapies fail to reach remission.

 

Many patients reaching remission still have severe pain, indicating a significant unmet need for medications that can effectively improve both remission rates and pain management.

 

"Rheumatoid arthritis is a condition that causes deformities in finger joints.

 

Patients with such deformities often find it difficult to grasp and self-administer injectables.

 

In one case, we prescribed an oral JAK inhibitor to a patient, but since the medication was not effective enough, we needed to switch back to an injectable.

 

However, the patient refused and chose to continue with the oral medication instead," Dr.

 

Hongexplained.

 

"Oral medications are a good option for patients who fear injections and are also beneficial for those who frequently travel or go on business trips.

 

While there are differences among medications, clinical research data indicates that oral therapies demonstrate high 'remission' rates, defined as a state with minimal symptoms, and are effective in improving morning stiffness, pain, and fatigue, offering significant benefits to patients," Dr.

 

Hong added.

 

Establishing patient-centered treatment landscape…"Supportive policies are needed" With drug switching between JAK inhibitors now granted reimbursement, effective treatments like Rinvoq may be quickly adopted in clinical practice.

 

Dr.

 

Hong remarks that doctors previously reserved highly effective therapies before drug switching approval, but due to changes in insurance reimbursement policy, this approach is no longer necessary.

 

"Several argued that Rinvoq should be used as a second-line treatment because of its significant efficacy, but this was when drug switching was not possible, and only one JAK inhibitor was available.

 

Now that drug switching is approved among multiple medications, there’s no reason to use a specific medication for later treatment.

 

When medication changes are needed due to ineffectiveness, doctors prioritize choosing the most effective treatment first," Dr.

 

Hong stated.

 

Rinvoq, whether used as a monotherapy or combined with existing DMARDs, has demonstrated superior clinical remission and low disease activity rates compared to placebo, MTX, or the biologic adalimumab (product name: Humira).

 

Additionally, Rinvoq's SELECT-BEYOND study, targeting patients with inadequate responses to biologic therapies, confirmed that patients maintained physical function while improving symptoms such as pain, fatigue, and morning stiffness in patient-reported outcomes (PRO) at Week 12.

 

Dr.

 

Hong shared that it is important to utilize available treatments, as new drugs are no longer being introduced.

 

An education course may be necessary to enhance patient compliance.

 

"Untreated rheumatoid arthritis can lead to disability, and the government may have to provide a lifelong support for patients with disability.

 

By preventing disabilities, significant social costs that the government has to be responsible for patient support can be reduced.

 

This is why doctors emphasize early diagnosis and treatment," Dr.

 

Hong said.

 

"Doctors have to care for patients, but having patients manage their diseases is also important.

 

Education allows patients to enhance disease-management skills." However, education costs are not covered for rheumatoid arthritis.

 

The government must provide education cost coverage to reduce social costs," Dr.

 

Hong stated.

 

"The pain mechanism and joint-destruction mechanism differ for rheumatoid arthritis, but patients simply associate the disease with joint pains.

 

Patients who are young children or elderlies may not understand well, so an education session must be conducted for both patients and caregivers," Dr.

 

Hong emphasized.