Topics of discussion at the annual ACR/ARHP in October 2018

The annual meeting of the American College of Rheumatology/American Rheumatology Health Professionals (ACR/ARHP) took place October 19-24 this year in Chicago, IL, and gathered together researchers, rheumatologists, specialists, primary care physicians, and several major industry players to discuss developments in the rheumatology space over the past year and to speculate on what the future may hold for the field.

I attended the meeting as DRG’s expert in axial spondyloarthritis, looking for evidence of new market trends that will be important to the immune space in the future. Although the ACR meeting had a huge number of events, a few topics emerged as potential drivers of market dynamics in 2019 and beyond. As we wrap up 2018, I want to share a few of these themes and how they intersect with DRG’s business capabilities.

Patient-reported outcomes (PROs):

Both physicians and patients expressed concern about the lack of patient-centered care. Physicians are all too familiar with rheumatology patients whose indication-specific disease composite score shows improvement following initiation of a new therapy but who report no change in their general feeling of wellness. In fact, few clinical trials collect information on fatigue and sleep quality – factors that impact patients’ daily quality of life. Therefore, physicians are increasingly interested in the inclusion of PROs in future clinical trials to help differentiate between new therapies. In addition, the use of non-pharmacological treatments such as physical therapy, in addition to pharmacological agents, may be crucial for patients to have a positive experience and choose to continue using a medication. The question of patient-centric outcomes is an issue in other disease spaces as discussed by two of DRG’s niche and rare disease team members, Dr. Dall’Osso and Dr. Love.

Potential for technology:

The use of technology, especially apps as well as artificial intelligence and machine learning tools that can assist patients and providers in making more informed and faster decisions, was a topic of discussion at ACR 2018. Physicians think technology may potentially also play a crucial role in precision medicine by helping to determine which patients will respond best to certain therapies. Our MedTech team has discussed ways technology is emergent in the overall healthcare system—for example, in medical imaging as well as the potential value medical technology may bring. In fact, physicians at ACR 2018 suggested that imaging may become increasingly important in rheumatology by helping determine a more accurate diagnosis earlier in the disease process, differentiating, for example, between rheumatoid arthritis and psoriatic arthritis.

Payer/Provider issues:

In rheumatology where chronic diseases are often treated by expensive biologics, equity of access and value-based contracting are always important topics of conversation. Treating rheumatologic disease earlier could be a long-term strategy to decrease the direct and indirect healthcare costs associated with the disease. Therapies available today for rheumatologists are of far higher value than in the past, and often allow patients to pursue much more active lives. Physicians and some payers are increasingly interested in eliminating arduous step-therapy or prior authorization requirements in favor of value-based contracting in hopes that treating patients earlier will help maintain their quality of life and lead to long-term savings. Our Market Access team is closely watching the interest in value-based contracting and the increasing influence of organizations like ICER in the United States. Biosimilars are a major point of equity of access and our Biosimilars Advisory Service is keeping an eye on how biosimilar development is different between the United States and Europe.

The role of the microbiome in rheumatologic disease:

The microbiome study session at ACR 2018 was packed with standing room only, suggesting the high level of interest in the role of the microbiome in rheumatologic disease. Although research on the immune-gut axis is still in early stages, the available evidence has shown intriguing results. In fact, preliminary evidence suggests the microbiome may play a key role in the development of individualized disease management strategies in rheumatology. DRG recently published its first Special Topics report covering emerging microbiome therapies (blog) in addition to a series of blog posts about the role the microbiome plays in different disease areas (101, FDA, multiple sclerosis, CNS, depression, NASH, obesity).

As we move into 2019, the experts at DRG are already thinking about both the exciting changes and the interesting challenges we expect to see in the next decade of therapeutic development and how those events will impact the rheumatologic markets.

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