Comparative Effectiveness in Rheumatology

Interesting times ahead I think.

  The Obama administration's new Comparative Effectiveness Research initiative seems to have rheumatological biologics in their sites.  That may or may not be a good thing. In one respect this is clearly welcomed.  There are now four anti-TNF drugs available in Canada with a fifth not far away.  Orencia, Rituximab and soon Actemra are the other biologics in the rheumatologist's arsenal. Weirdly, almost every biologic has clinical studies with near identical results for ACR 20, 50 and 70.  Side effect profiles are hard to compare because the important ones, infection and cancer, don't seem to be very high in these studies.  Large databases are starting to tease out some results but not much, and not quickly. Getting to that information isn't so easy either.  Each pharma company brings over the European database researcher that seems to best support their drug, or at least some tiny advantage that they may have tumbled upon.  So it would be nice to have a third party, a party with a little oomph and a little cash,  try to look at all the data and try to sort things out. Head to head trials would be great but I don't think there will be enough cash in the till to do an adequate job with the biologics.

On the down side, and a worry for everybody, is whether the information gleaned will be used to limit choice.  It's a little less a concern here in Canada as in Britain, only because we are already acclimatized to government interference.  In Britain, for example, Orencia will not be covered for RA.  It is in Quebec, but with numerous criteria.  The criteria established are not horribly onerous but the paperwork is.  And it could get worse after the Comparative Effectiveness Research gets rolling.

So there could be some bad with the good, but overall, I think I'm ready for a non-pharmaceutical company based appraisal of the biologics.  

Comments

[John Walk]

Hi,

I just came across your blog and thought you might be interested in this online Rheumatology CME course.

http://www.cmenetworks.com/cme/10845/1/Continuing-Medical-Education-Rheumatology-CME-2009-Latest-Developments-in-Biologics-for-Rheumatoid-Arthritis-From-Science-to-Practice-Scientific-Congress-Update-December-19-2008---December-18-2009/Page1.html

This one hour highlight review is provided by Scientific Congress Updates. The video covers some interesting topics like the latest clinical advances in use of biologics in the treatment of Rheumatoid Arthritis. Make sure you watch the whole video so you won’t miss it and the CME credit!

John