Rheumatoid arthritis

EULAR president’s predictions for rheumatology in 2020

Professor McInnes

The start of a new decade brings with it a raft of new treatment options and an exciting new time for rheumatology, says EULAR president Professor Iain McInnes.

Speaking to the limbic, Prof McInnes, Director of the Institute of Infection, Immunity and Inflammation at the University of Glasgow, says rheumatologist can expect a rapidly evolving world  of increasingly targeted and cost-effective treatments.

“We continue to see the introduction of targeted new medicines which are showing great success particularly in inflammatory disease, for example new JAK inhibitors in rheumatoid arthritis,” he says.

“We are also anticipating the arrival of new biologics in 2020 which will be especially useful in psoriatic arthritis,” he adds.

“We are also hoping for new advances in systemic lupus erythematosus as there are some really interesting trials going on in lupus and we hope we will finally see some progress there. There is some interesting data that we hope will be revealed to us in the coming year.”

From a EULAR perspective, he points to expected publication of several of key recommendations for the treatment of major diseases and says as well as continuing to build educational resources, one of their main areas of focus is building international collaboration.

“We are excited to increase our relationships across the global community US, Asia South America and Africa. And we will be looking to increase global appreciation of what rheumatic disease means for patients, families, and employers and in 2020 we will be working really hard to raise awareness of that.”

One of those EULAR recommendations is on psoriatic arthritis an area which Professor McInnes agrees has been slow to progress but believes is now on the cusp of some important developments.

“We have just had a really exciting decade but this next decade is going to be even better. If you look beyond 2020 we are going to see the arrival of precision medicine, better medicine, more global cooperation and radical improvements in the quality of life for patients and we are going to do that more cost-effectively.”

He adds: “As our options grow we can choose better medicine for the right people at the right time effectively so we will be able to deliver better care for less money.”

The editor-in-chief of Rheumatology, Dr Marwan Bukhari, told the limbic he is equally enthused about the new treatment options breaking through over the next year.

We are now very firmly into the era of small molecule drugs such as upadacitinib and filgotinib that will change the care of all rheumatic diseases, according to Dr Bukhari, consultant rheumatologist at the University Hospitals of Morecambe Bay NHS foundation.

“And we have been getting more biosimilars as drugs are coming off patent. And we are going to get more and more of these,” he says.

Ultimately this means more choice and changes in treatment thresholds as medicines become cheaper, predicts Dr Bukhari.

“From the point of view of other disease there have been some interesting trials. And there is some important work is in interstitial lung disease where we now have antifibrotics we can use and there will be some important developments here in 2020 as well.”

What it means for rheumatology is how to choose the right treatment for the right patient. “That will be the dilemma”, he explains.

“We are also having to learn to reclassify disease a bit better. Classically we have done this with symptoms but we are starting to know more about biomarkers, etc, so we will be moving towards tailoring treatment. We are discovering more and more ways of looking at molecular profiles.”

 “It is an exciting time to be a rheumatologist because in the past 20 years we have had more than 35 new molecules but in the 20 years before that we had only four. And importantly we are starting to use existing drugs for new indications and applying them to different circumstances.”

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