"TNF blockers in rheumatoid arthritis is a symbol of trust"

[Interview] Professor Kim Geun-tae at Kosin University Hospital Division of Rheumatology

Professor Kim Geun-tae

A tumor necrosis factor (TNF)-α inhibitor was a game changer for the rheumatoid arthritis (RA) treatment scene.

 

An autoimmune disease RA, which causes break down in joints and bone tissues with abnormal immune reaction, has prevalence rate in female patients approximately 0.3 percent to 1 percent higher than male patients.

 

According to South Korea’s Health Insurance Review and Assessment Service (HIRA), about 250,000 patients in South Korea are diagnosed with RA, annually.

 

And biologic therapies were a breakthrough in the chronic RA treatment scene.

 

The biologic therapy for RA, such as Humira (adalimumab), Enbrel (etanercept) and Remicade (infliximab) blocking TNF-α and helping to stop inflammation, targets T-cell co-stimulation or B-cell prior to the inflammatory reaction stage.

 

And recently, the treatment options for RA have expanded with orally taken Janus kinase (JAK) inhibitors like Xeljanz (tofacitinib), Olumiant (baricitinib) and Rinvoq (upadacitinib).

 

However, the healthcare providers’ trust in TNF-α inhibitors is sound.

 

Kim Geun-tae, a professor at Kosin University Hospital Division of Rheumatology said, “The healthcare providers would always welcome a new selection of treatment options.

 

There are new drugs with new mechanism of action that improves administration convenience.

 

But to this day, I usually choose TNF-α inhibitors as a first-line therapy after prescribing methotrexate (MTX).

 

Almost two decades of prescription experience is an asset you cannot ignore.” Professor Kim added, “It would depend on the patient’s condition, but I personally prefer Humira for the balance in safety and efficacy.

 

Of course, other treatments are prescribed strategically as well.

 

Depending on infection (tuberculosis and etc.), adverse reaction, and administration route, I also prescribe other TNF-α inhibitors like Enbrel and Remicade.” But there is inevitable fear of injection among patients.

 

Especially, the user reactions on the pain from the injected TNF-α inhibitor are split.

 

A study found the pain from Humira injection was the worst.

 

Regarding the issue, Professor Kim explained, “Injection could be painful.

 

The Humira brand is doing its best to improve the administration experience for the patients, such as releasing the citrate-free injection in 2017 to remove the pain-causing citrate.

 

And now we have less patients complain about the pain thanks to the pharmaceutical companies’ efforts.” He also elaborated, “We even have to instruct the patients to not remove the syringe until all the content is injected as now they assume the injection is done before it is with the significantly improved level of pain from the new injection type.” The professor was rather concerned of the patients, who try to manage RA through bad folk remedy, instead of proper pharmaceutical therapy.

 

“Some miss the appropriate treatment period, as they refuse to take the drug or explore for a cure in unverified folk remedy.

 

The prognosis of RA heavily depends on the early detection and treatment.

 

RA is a chronic inflammatory disease that requires a life-long management.

 

To treat RA, taking anti-rheumatic drugs is crucial,” he added.

 

Wrapping up the interview, Professor Kim stressed, “As for exercises, I would recommend stretching or yoga that increases range of motion.

 

Although the patients should avoid strenuous exercises, working out two to four hours a week would improve disease activity and the disorder.”