Center for Independent Healthcare Education

No Patient Left Behind: Building the Case for Early RA Therapy
Clinical Update 1: From the EULAR Congress 2009

Medium: Podcast (with RSS Feed)
Accreditation Expired

Credit Hours

Physician CME: 0.75
Physician Assistants Hours: 0.75

Initiative Overview

This Podcast is part of the Initiative No Patient Left Behind: Building the Case for Early RA Therapy which consists of multiple, sequential CME activities.

The first educational activity in this Initiative was a live meeting in Philadelphia and simultaneous webcast. This is now available as Webcast On-Demand in which experts in rheumatology discuss scientific evidence and its application to clinical practice through a case series.
Podcast is the next learning step in this Initiative. It focuses on the latest research related to undifferentiated arthritis and early rheumatoid arthritis. Podcast consists of 3 educational activities:

Clinical Update 1: From the EULAR Congress 2009
Clinical Update 2: From the Literature 2009
Clinical Update 3: From the ACR 2009 Annual Scientific Meeting

Activity Overview

Clinical Update 1 consists of 2 episodes (release date: August 10, 2009 and August 31, 2009) featuring highlights related to undifferentiated arthritis and early rheumatoid arthritis from the Annual European Congress of Rheumatology or the EULAR Congress, June 2009, Copenhagen, Denmark.

In Episode 1, Dr. Schiff and Dr. Massarotti discuss

the data on the use of an oral Janus-associated kinase inhibitor, also known as JAK inhibitor, in moderate to severe rheumatoid arthritis. JAK inhibitors are the first oral biologic agents being developed for the treatment of rheumatoid arthritis. Two studies pertaining to the JAK inhibitor, CP-690,550, presented at the EULAR Congress are discussed in this Episode.
the analysis from the PROMPT study—a prospective, randomized, double-blind, placebo-controlled study that investigated the presence of anti-CCP antibodies as a criterion to start active therapy in patients with undifferentiated arthritis. The objective of the analysis presented at the EULAR Congress was to determine whether the effect of methotrexate therapy on disease activity parameters and patient-reported symptoms is different based on the presence or absence of anti-CCP antibodies in patients with undifferentiated arthritis.
the 2-year results of the ATTEST trial—a randomized, double-blind, placebo-controlled trial that compared abatacept or infliximab with placebo in patients with rheumatoid arthritis who had an inadequate response to methotrexate. Patients who completed the one-year double-blind phase of this study were entered into the open-label long-term extension and were given abatacept 10 mg/kg. The Year 1 results of the double-blind phase of the ATTEST trial were recently published by Dr. Schiff and his colleagues in the journal, Annals of Rheumatic Diseases. The results of the open-label phase were presented at the EULAR Congress.

In Episode 2, Dr. Schiff and Dr. Massarotti focus on

the results from the AGREE trial—a multinational, double-blind, randomized trial that compared abatacept and methotrexate combination therapy with methotrexate monotherapy in methotrexate-naïve patients with early rheumatoid arthritis and poor prognostic factors. Two follow-up studies from this trial were presented at the EULAR Congress. The first evaluated the health-related quality of life benefits, including improvements in fatigue and activity limitation, observed with abatacept and methotrexate combination therapy over 1 year. The second study was a post-hoc analysis to assess improvements in disease activity with abatacept and methotrexate combination therapy from both the physician and patient perspective.
the results from the COMET trial—a randomized, double-blind trial that compared etanercept and methotrexate combination therapy with methotrexate monotherapy in patients with early moderate to severe rheumatoid arthritis. During Year 2 of the COMET trial, patients who initially received combination therapy were randomized to either continue it or were switched to etanercept monotherapy. Patients who initially received methotrexate monotherapy were randomized to either continue it or were switched to etanercept and methotrexate combination therapy. The Year 2 results of this trial were presented at the EULAR Congress.

Educational Overview

There has been remarkable progress in the therapy of rheumatoid arthritis (RA), related in part to a better understanding of the pathogenesis of this disease. The development of several effective and safe novel therapeutic options has contributed to a shift in the treatment paradigm that now focuses on early and aggressive management supported by increasing evidence of the clinical and radiographic benefits of initiating DMARD treatment early in the course of the disease. These benefits include a reduction in the risk of associated comorbidities, in particular cardiovascular disease. Clinical remission has become an attainable goal and improved patient quality of life is now an expected outcome. All these developments have made “no patient left behind” a definite possibility.

Against this backdrop, healthcare professionals caring for patients with early RA need to be armed with the latest knowledge about ways in which to individualize therapy to achieve patient-specific goals.

Target Audience

This educational activity has been developed for rheumatologists, physician assistants, and other healthcare professionals responsible for the management of patients with early RA.

Purpose Statement

The purpose of this activity is to educate rheumatologists, physician assistants, and other healthcare professionals responsible for the management of patients with early RA on the benefits of aggressive, early RA therapy and patient-centered management to achieve customized goals. With this knowledge, healthcare professionals will be able to tailor therapy to meet patient-specific goals making “no patient left behind” a reality.

Learning Objectives

After completing this educational activity, learners should be able to:

Recognize the benefits of pharmacotherapy for early rheumatoid arthritis (RA), including undifferentiated arthritis
Compare the safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologic agents for the treatment of RA

Faculty

Elena M Massarotti, MD

Associate Professor of Medicine, Harvard Medical School
Co-Director, Center for Clinical Therapeutics
Division of Rheumatology
Brigham and Women’s Hospital
Boston, MA

Michael H Schiff, MD

Clinical Professor of Medicine, Rheumatology Division
University of Colorado School of Medicine
Denver, CO

Accreditation

Physicians

Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship of Center for Independent Healthcare Education (Center) and Vemco MedEd. Center is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: Center designates for this activity a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Physician Assistants

American Academy of Physician Assistants accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME. Physician assistants may receive a maximum of 0.75 hours of Category I credit for completing this activity.

For questions regarding the accreditation of this activity, please contact Center at info@jointsponsor.com.

Method of Participation and Instructions for Credit

Review the entire CME information including target audience, learning objectives, and disclosures.
Review the two episodes.
Print and complete the Post Test, Evaluation, and Credit Application form.
Mail the completed Post Test, Evaluation, and Credit Application form to Vemco MedEd, 245 US Highway 22, Suite 304, Bridgewater, NJ 08807 Or Fax to (908) 450-3300.

Documentation of credit will be mailed within 4 weeks of receipt of the completed Post Test, Evaluation, and Credit Application form.

Note: If you have received credit by attending the live symposium or simulcast by the same name, you are not eligible to apply for credit for this online version.

Disclosure of Conflict of Interest

Center for Independent Healthcare Education requires faculty, planners, and others who are in a position to control the content of continuing education activities to disclose to the audience any real or apparent conflict of interest related to the activity. All identified conflicts of interest are reviewed to ensure fair balance, objectivity, and scientific rigor in all activities. The faculty is further required to disclose discussion of off-label uses in their presentations.

Disclosures

Faculty

Michael H Schiff, MD

Advisor/consultant: Abbott, Bristol-Myers Squibb, Amgen, UCB, Novartis, Bayer, Roche, and Array BioPharma
Promotional speaker’s bureau: Abbott

Elena M. Massarotti, MD

Grant/research support: UCB, Genentech, and EMD Serono
Advisor/consultant: Bristol-Myers Squibb, Pfizer, UCB, Genentech, and EMD Serono

Planning Committee Members

Employees of Center for Independent Healthcare Education and Vemco MedEd have no relevant financial relationships to disclose.

Disclosure of Off-Label Use

In Episode 1, the following investigational antirheumatic agent (as of July 2009) is discussed: oral JAK inhibitor (CP-690,550) for the treatment of rheumatoid arthritis.
In Episode 2, off-label use of antirheumatic agents is not discussed.

Joint Sponsorship

This activity is jointly sponsored by Center for Independent Healthcare Education and Vemco MedEd.

Commercial Support

This activity is supported by an educational grant from Bristol-Myers Squibb.

Fee

There is no fee to participate in this educational activity.

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Copyright Statement

Disclaimer

The opinions expressed in this educational activity are those of the faculty and do not reflect the views of Center for Independent Healthcare Education (Center) and Vemco MedEd. This educational activity may discuss off-label and/or investigational uses and dosages for therapeutic products/procedures that have not been approved by the United States Food and Drug Administration (FDA). Center and Vemco MedEd do not recommend the use of any product/procedure outside of the labeled indications. A qualified healthcare professional should be consulted before using any therapeutic product/procedure discussed. Learners should verify all information and data before treating patients or employing any therapies described in this continuing education activity. Please refer to the official prescribing information for each product/procedure for approved indication, contraindications, and warnings.

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Contact Information

For questions regarding the accreditation of this activity, please contact Center for Independent Healthcare Education at info@jointsponsor.com

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