EULAR 2008 Highlights From Ronald F. van Vollenhoven, MD, PhD
EULAR 2008 Highlights From Ronald F. van Vollenhoven, MD, PhD
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Ronald van Vollenhoven, MD: Hello, my name is Ronald van Vollenhoven. I am a rheumatologist and clinical investigator at the Karolinska University Hospital in Stockholm, Sweden, and I am here at the EULAR 2008 annual meeting in the wonderful city of Paris [France], which is a great location for an excellent, excellent rheumatology meeting. This has really become one of the highlights of the year when the health professionals and the patients get together for the EULAR annual meeting to share ideas, advances, and to hear about the latest updates in basic and clinical rheumatology science.
Some of the highlights for the meeting have definitely been the reports of new agents for patients with rheumatic diseases. It has been very exciting to hear both about new agents that are not yet available, but that are going in clinical trials, and about new uses of established agents where the efficacies and the safety results are looking very good even with prolonged periods of treatments.
I think among the new agents, we are excited that there are 2 new anti-TNF [antitumor necrosis factor] agents that are being studied in phase 3 trials, golimumab and certolizumab. These 2 agents, with some differences compared to existing anti-TNF agents, are going to most likely be available to the clinician in another 1 or 2 years, so it is important at this time to get results. Overall, the results do look very promising. One interesting study showed that even patients who failed other anti-TNF agents could benefit from golimumab therapy.
Another important development is the use of the established agents in situations where the patient has already failed other treatments, and we are increasingly seeing that treating with sequential biologics can provide patients with very good relief and make sure that the disease can be controlled even for longer periods of time.
Interestingly, it has been shown that treating sequentially does not significantly increase the safety aspects, so that patients are not exposed to a greater risk by switching from one biologic perhaps with one mode of action to another one with a different mechanism of action.
I was very interested by some discussions about the concept of remission. Remission is something that is very intuitive. We think that is what we want to achieve if possible for each patient, but of course it may not always be possible yet, but we hope we will get there in the future; we have to find ways of defining it and using the concept in a productive way.
Some definitions were discussed at the session on clinical aspects of rheumatoid arthritis, and there were some differing views on how to define remission and what is best to use in clinical trials and how to do it in clinical practice. For me, the bottom line is that we can use remission definitions in clinical trials, but at the individual patient level we still very much have to use our own insight as an experienced rheumatology physician to make the determination that the patient is at the right level of having the disease activity under control.
So some of the data from the BeSt trials from The Netherlands, which have of course been published and reported on many times, now suggest that a sizeable proportion of patients -- around 18% -- can achieve [disease] remission even without any further treatment after the first 2 years have been characterized by intensive therapy and a real determined effort to get the disease activity as low as possible, and as quickly as possible. Although that is just one particular example, I think there are many other ways to try to achieve the same things: a very rapid disease control and having the disease under control for a long period of time, but maybe not many years -- but maybe 1 or 2 years -- and then see if you can discontinue some of the treatments and perhaps reduce the necessity for having patients being exposed to what also could be side effects or long-term risks. There are additional interests in that because of the health economics implications that are also going to look very favorable if we can reduce treatment after the patients have achieved remission.
There have been some interesting new papers on systemic lupus erythematosus, but the truth of the matter is that right now a large number of trials, more than ever before in lupus, are ongoing, and so actually right now many in the rheumatology community are waiting for results from those trials. What is exciting is that at the same time as the trials are ongoing we are learning much more about how to measure lupus, how to assess the patients properly, and also what other quality-of-life issues are playing an important role in that disease.
There are always some topics that come up during a meeting that you could say are bad news. Fortunately, there have been no major bad news at this meeting, but I think some presentations did underline the serious aspects of the rheumatic diseases. We have been given presentations here at EULAR that confirm that cardiovascular risk is a real issue for patients with rheumatoid arthritis, something we as a community also must be aware of and try to take measures against.
There have been a number of presentations here at EULAR about the risk associated with treatments, but there was some good news that I heard today, which I want to share with you. If a patient is being treated with biologics, specifically with anti-TNF, and the patient gets cancer (this can happen although it is not an increased risk with the anti-TNF, but it can happen), current data show that the prognosis of the cancer is not negatively influenced by the anti-TNF treatment. This is from the Swedish registries where it turns out that those patients who, unfortunately, developed cancer during anti-TNF treatment had the same prognosis as others with the same type of cancer.
Thank you very much.
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Take this Commentary with you!
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Ronald van Vollenhoven, MD: Hello, my name is Ronald van Vollenhoven. I am a rheumatologist and clinical investigator at the Karolinska University Hospital in Stockholm, Sweden, and I am here at the EULAR 2008 annual meeting in the wonderful city of Paris [France], which is a great location for an excellent, excellent rheumatology meeting. This has really become one of the highlights of the year when the health professionals and the patients get together for the EULAR annual meeting to share ideas, advances, and to hear about the latest updates in basic and clinical rheumatology science.
Some of the highlights for the meeting have definitely been the reports of new agents for patients with rheumatic diseases. It has been very exciting to hear both about new agents that are not yet available, but that are going in clinical trials, and about new uses of established agents where the efficacies and the safety results are looking very good even with prolonged periods of treatments.
I think among the new agents, we are excited that there are 2 new anti-TNF [antitumor necrosis factor] agents that are being studied in phase 3 trials, golimumab and certolizumab. These 2 agents, with some differences compared to existing anti-TNF agents, are going to most likely be available to the clinician in another 1 or 2 years, so it is important at this time to get results. Overall, the results do look very promising. One interesting study showed that even patients who failed other anti-TNF agents could benefit from golimumab therapy.
Another important development is the use of the established agents in situations where the patient has already failed other treatments, and we are increasingly seeing that treating with sequential biologics can provide patients with very good relief and make sure that the disease can be controlled even for longer periods of time.
Interestingly, it has been shown that treating sequentially does not significantly increase the safety aspects, so that patients are not exposed to a greater risk by switching from one biologic perhaps with one mode of action to another one with a different mechanism of action.
I was very interested by some discussions about the concept of remission. Remission is something that is very intuitive. We think that is what we want to achieve if possible for each patient, but of course it may not always be possible yet, but we hope we will get there in the future; we have to find ways of defining it and using the concept in a productive way.
Some definitions were discussed at the session on clinical aspects of rheumatoid arthritis, and there were some differing views on how to define remission and what is best to use in clinical trials and how to do it in clinical practice. For me, the bottom line is that we can use remission definitions in clinical trials, but at the individual patient level we still very much have to use our own insight as an experienced rheumatology physician to make the determination that the patient is at the right level of having the disease activity under control.
So some of the data from the BeSt trials from The Netherlands, which have of course been published and reported on many times, now suggest that a sizeable proportion of patients -- around 18% -- can achieve [disease] remission even without any further treatment after the first 2 years have been characterized by intensive therapy and a real determined effort to get the disease activity as low as possible, and as quickly as possible. Although that is just one particular example, I think there are many other ways to try to achieve the same things: a very rapid disease control and having the disease under control for a long period of time, but maybe not many years -- but maybe 1 or 2 years -- and then see if you can discontinue some of the treatments and perhaps reduce the necessity for having patients being exposed to what also could be side effects or long-term risks. There are additional interests in that because of the health economics implications that are also going to look very favorable if we can reduce treatment after the patients have achieved remission.
There have been some interesting new papers on systemic lupus erythematosus, but the truth of the matter is that right now a large number of trials, more than ever before in lupus, are ongoing, and so actually right now many in the rheumatology community are waiting for results from those trials. What is exciting is that at the same time as the trials are ongoing we are learning much more about how to measure lupus, how to assess the patients properly, and also what other quality-of-life issues are playing an important role in that disease.
There are always some topics that come up during a meeting that you could say are bad news. Fortunately, there have been no major bad news at this meeting, but I think some presentations did underline the serious aspects of the rheumatic diseases. We have been given presentations here at EULAR that confirm that cardiovascular risk is a real issue for patients with rheumatoid arthritis, something we as a community also must be aware of and try to take measures against.
There have been a number of presentations here at EULAR about the risk associated with treatments, but there was some good news that I heard today, which I want to share with you. If a patient is being treated with biologics, specifically with anti-TNF, and the patient gets cancer (this can happen although it is not an increased risk with the anti-TNF, but it can happen), current data show that the prognosis of the cancer is not negatively influenced by the anti-TNF treatment. This is from the Swedish registries where it turns out that those patients who, unfortunately, developed cancer during anti-TNF treatment had the same prognosis as others with the same type of cancer.
Thank you very much.
