The past decade has seen several new classes of biologic drugs approved by the Food and Drug Administration for treating rheumatoid arthritis, but despite this cornucopia the field is in something of a holding pattern. None of the biologic options really stand out from the competition, said Dr. Roy Fleischmann, a Dallas-based rheumatologist with an active practice who has participated in countless new-drug trials over the years.
The best to be said for the wide variety of biologic treatment options available today is that they allow switching from one class to another to find what works best for each individual rheumatoid arthritis patient, Dr. Fleischmann told me when I spoke with him in June at the European Congress of Rheumatology.
Dr. Roy Fleischmann
“In my practice, I constantly change drugs,” and by doing so and finding what works he gets about half his patients into sustained remission, he said.
But when he looks at the range of biologics available today “it’s pretty clear that it makes no difference what you use. I could use a tumor necrosis factor [TNF] inhibitor, I could use abatacept [Orencia]. I could use tocilizumab [Actemra], Rituxan [rituximab], tofacitinib [Xeljanz]. I can use any of them. I can use them first-line or second-line, and I’ll probably see the same results.”
Rheumatologists in U.S. practice today generally turn to a TNF inhibitor first, but that’s “because of habit,” Dr. Fleischmann said. “They often say they have more experience with the TNF inhibitor,” but the safety of all the biologics approved for rheumatoid arthritis seems generally the same, he said. “The truth is you can use any of them.”
He also discounted the prospect that, someday, biosimilar TNF inhibitors may be on the U.S. market and edge the competition on price, saying that he remains skeptical and cautious about using a biosimilar infliximab or another biosimilar TNF inhibitor. Plus, as of now, no biosimilar suitable for treating rheumatoid arthritis has received U.S. approval.
Among the bio-originals with U.S. approval for rheumatoid arthritis, clinicians could start patients on whichever they want. “I don’t think it makes a difference which bio-original you use,” Dr. Fleischmann said.
Dr. Fleischmann said that he’s consulted for and has received research support from most of the companies that have developed and market biological drugs for rheumatoid arthritis.
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