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Rheumatoid Arthritis: Too expensive to treat, too expensive to fail
- 1. “Rheumatoid Arthritis Too expensive to treat, too expensive to fail? Iain B McInnes PhD, FRCP, FRSE, FMedSci Professor of Medicine & Director, Institute of Infection, Immunity and Inflammation, University of Glasgow Scotland, UK
- 2. From Whence We Have Come… Used with permission from Scott DL, et al. Lancet. May 16 1987;1(8542):1108-1111. ©1987 Elsevier.
- 3. Disease duration: 1.5 years 5 years 15 years SHARP score: 23 SHARP score: 56 SHARP score: 96 Rheumatoid arthritis – progressive damage
- 4. RA – the wider perspective?
- 5. Impact of RA Patients Pain, disability, co-morbidity and premature mortality Health Care Direct Costs ~ €14 Billion (Europe)1 – hospitalisation, treatment, diagnostics Societal Indirect Costs ~ €17 Billion (Europe) – productivity and informal costs – within 10 years of disease onset >50% of people unable to work Global drug market $38.5 Billion in 20172 1. Lundkvist J et al. The burden of RA and access to treatment: health burden and costs. Eur J Health Econ (2008) 8:49–60 2. Visiongain, April 2013. Rheumatoid Arthritis (RA): World Drug Market 2013-2023
- 6. NSAIDs GC +DMARD A pre-molecular history of arthritis management... Willow (Salix) Johann Andreas Buchner SALICIN 1829 1948 1994 ACTH, MTX
- 7. 7 Lessons from a decade: molecular hierarchies exist Many vulnerable nodes in inflammatory cascade – cell receptors and their requisite signalling pathways? Cytokine-targeting biologics APC Cell-targeting biologics Inhibition of T-cell activation Blocks co-stimulatory signal Abatacept MHC Antigen T-cell receptor T cell CD28 Depletion of B cells Rituximab CD20 B cell Tocilizumab Blockade of IL-6R classic and trans signalling pathways Blockade of TNF signalling pathways Anti-TNFs Extracellular Intracellular IL-1 TNF Anti-IL-1s
- 8. AID, autoinflammatory disease including Still’s disease; CD, Crohn’s disease; GCA, giant cell arteritis; IL, interleukin; JIA, juvenile idiopathic arthritis; RA, rheumatoid arthritis; SpA, spondyloarthritis; TNF, tumor necrosis factor; UC, ulcerative colitis Lessons from a decade: Towards molecular taxonomy in inflammation medicine? Schett G, McInnes IB et al. Nature Med 2013 McInnes IB et al Lancet 2015
- 9. 9 Lessons about strategies? ‘Treat to target'… but ‘knowing when to stop?’ Adapted from Smolen JS et al (2015) Ann Rheum Dis doi:10.1136/annrheumdis-2015-207524 Therapeutic taper ? Drug-free remission
- 10. Smolen J, Aletaha D & McInnes IB Lancet (2016): Smolen J & Aletaha D Nature Reviews Rheum (2015) RA – pathogenesis and therapeutics?
- 11. 11 Do we really need a personalised medicine based approach? Porter D et al Lancet 2016
- 12. 12 To the future: Scottish Early RA Collaboration 1200 Scottish Nested Arthritis Progression Study • >50 new RA • Deep immune phenotyping
- 13. EU FP7: Masterswitch BTCure, TEAM University of Glasgow Paul Garside James Brewer Carl Goodyear Simon Milling Mariola Kurowska-Stolarska Gerard Graham Derek Gilchrist Neal Millar Jagtar Nijjar Singh Bill Ferrell John Lockhart Roger Sturrock Hilary Capell Foo Liew Darren Asquith Ashley Miillar Aziza Elmesmari James Reilly Shauna Kerr Lynn Stewart Clare Tange Axel Hueber Bob Benson Cat Prendergast George Fragoulis Catholic University of the Sacred Heart, Rome Stefano Alivernini Giacoma Ferraccioli ARUK Centre John Isaacs Chris Buckley Marina Frleta Lynn Stewart Ashleigh Rainey Clare Tange Marina Frleta Donna McIntyre Derek Baxter Brian Morton Bernard Leung Charles McSharry Florian Meier SERA Duncan Porter Stefan Siebert Caron Paterson Sharon Kean Jane Hair Ashley Gilmour Carl Goodyear Edinburgh University Stuart H. Ralston Aberdeen University David Reid Neil Basu Janet Liversidge