Archive for the ‘Articles’ Category

Honing in on new drug treatments for lung cancer

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APAR KISHOR GANTI, MD

Lung cancer has long been a mystery – as we didn’t know much, until the past decade, about the vast number of what we call “non-small cell lung cancers.”

More recently, one discovery after another has revealed the secrets. We now can identify certain categories of these tumors. We know that a large number — 40% — are a type called adenocarcinomas. Pemetrexed is a chemotherapy drug that seems to benefit patients with lung adenocarcinomas. Upwards of 30 percent of patients have a good response to it.

Within the group of adenocarcinomas, we have also identified many sub-types, the most common being K-RAS, EGFR and ALK.

We now have a very exciting tool called molecular tumor testing, which allows us to test a patient’s tumor to determine which type it is, and determine treatment based on that type.

This has revolutionized lung cancer treatment for some patients. But it hasn’t solved all our treatment problems. Let’s look at the three sub-types of lung cancer, and the drugs.

EGFR: EGFR (epidermal growth factor receptor) tumors. Patients with these tumors have had success with a drug named Iressa, introduced in the early 2000s. In one study, this drug eradicated the tumors within weeks – nearly a miracle!

Unfortunately back then, we did not know what caused this drug to work miracles in some patients, but not others. But research showed that patients who responded to these drugs had a mutation in the EGFR gene — and there are two drugs approved in the US for these patients; erlotinib and afatinib. Almost 55-60% of patients with these mutations will respond to these drugs, rates that are unheard of with conventional chemotherapy.

ALK: ALK, or anaplastic lymphoma kinase is a gene, which when activated, seems to promote the growth of lung cancers. Two drugs are used to treat this particular mutation: Crizotinib and Ceritinib. Up to 60 percent of patients have consistently responded to these drugs – almost double the response to conventional chemotherapy.

K-RAS: Former and current smokers with lung cancer tend to have the K-RAS sub-type, which is caused by a gene mutation. We are still working to understand this mutation. To date, we don’t have specifically targeted treatments for this subtype, but researchers are hard at work on this.

As you see, this growing body of knowledge has helped many patients. But we still have unanswered questions for many others—specifically, people who smoke.  Nevertheless, these advances give much more optimism.

I do not believe that we should accept that three quarters of patients will not respond to chemotherapy and do nothing about it. I always encourage those patients to enroll in a clinical trial. Why would you not, when a new treatment approach might give you a better chance? You’ll possibly help extend your own life – and you will certainly help advance our medical understanding of this disease.

At Nebraska Medicine, our service is designated by the National Cancer Center as a Lung Cancer Alliance Screening Center of Excellence. This reflects our team’s experience as well as our multidisciplinary program in managing patient care.

With this level of expertise, you will receive the treatment that specifically targets your lung cancer sub-type. We’ll stay with you every step of the way, making sure you’re getting excellent care.

Nebraska Medicine/UNMC, Nebraska DHHS Selected As Special Pathogen Treatment Center

The U.S. Department of Health and Human Services has selected nine health departments and associated partner hospitals to create a new network to respond to outbreaks of severe, highly infections diseases. The Nebraska Department of Health and Human services in partnership with Nebraska Medicine – Nebraska Medical Center is one of the nine facilities on the list.

Nearly $30 million of federal funding will be coming from HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) to enhance the regional treatment centers’ capabilities to care for patients with Ebola or other similar illnesses. “This approach recognizes that being ready to treat severe, highly infectious diseases, including Ebola, is vital to our nation’s health security,” said Dr. Nicole Lurie, HHS assistant secretary for preparedness and response. “This added regional capability increases our domestic preparedness posture to protect the public’s health.”

“We are very grateful for the trust being shown to us by HHS in naming Nebraska Medicine as one of these regional centers,” said Jeffrey P. Gold, M.D., chancellor of the University of Nebraska Medical Center and chairman of the Nebraska Medicine Advisory Board. “Our track record in caring for Ebola patients is certainly a contributor toward achieving this goal, but this is also a credit to the countless individuals at Nebraska Medicine and UNMC who have continued to work tirelessly to ensure we continue to be at the forefront of the nation’s and world’s fight against the deadliest of diseases.”

Dr. Gold also said Nebraska Medicine and UNMC’s continuing effort in training hundreds of other medical experts from around the country and around the world in the best practices for handling patients with highly infectious diseases played a role in the selection.

“Our agency has partnered with Nebraska Medicine – Nebraska Medical Center for more than 10 years. They have the facility and the expertise to provide specialized care to people with highly infectious diseases like Ebola,” said Jenifer Roberts-Johnson, deputy director of the Division of Public Health for the Nebraska Department of Health and Human Services. “We’re pleased to continue our work together to further increase our level of preparedness and help protect the health of our citizens.”

Each awardee will receive approximately $3.25 million over the full five-year project period. This funding is part of $339.5 million in emergency funding Congress appropriated to enhance state and local public health and health care system preparedness following cases of Ebola in the United States stemming from the 2014 Ebola epidemic in West Africa.

The facilities announced today will be continuously ready and available to care for a patient with Ebola or another severe, highly infectious disease, whether the patient is medically evacuated from overseas or is diagnosed within the United States.

The nine awardees and their partner hospitals are:
•Massachusetts Department of Public Health in partnership with Massachusetts General Hospital in Boston, Massachusetts
•New York City Department of Health and Mental Hygiene in partnership with New York City Health and Hospitals Corporation/HHC Bellevue Hospital Center in New York City
•Maryland Department of Health and Mental Hygiene in partnership with Johns Hopkins Hospital in Baltimore, Maryland
•Georgia Department of Public Health in partnership with Emory University Hospital and Children’s Healthcare of Atlanta/Egleston Children’s Hospital in Atlanta, Georgia
•Minnesota Department of Health in partnership with the University of Minnesota Medical Center in Minneapolis, Minnesota
•Texas Department of State Health Services in partnership with the University of Texas Medical Branch at Galveston in Galveston, Texas
•Nebraska Department of Health and Human Services in partnership with Nebraska Medicine – Nebraska Medical Center in Omaha, Nebraska
•Colorado Department of Public Health and Environment in partnership with Denver Health Medical Center in Denver, Colorado
•Washington State Department of Health in partnership with Providence Sacred Heart Medical Center and Children’s Hospital in Spokane, Washington

The regional facilities are part of a national network of 55 Ebola treatment centers, but will have enhanced capabilities to treat a patient with confirmed Ebola or other highly infectious disease. Even with the establishment of the nine regional facilities, the other 46 Ebola treatment centers and their associated health departments will remain ready and may be called upon to handle one or more simultaneous clusters of patients.

The facilities selected to serve as regional Ebola treatment centers will be required to:
•Accept patients within eight hours of being notified,
•Have the capacity to treat at least two Ebola patients at the same time,
•Have respiratory infectious disease isolation capacity or negative pressure rooms for at least 10 patients,
•Conduct quarterly trainings and exercises,
•Receive an annual readiness assessment from the soon-to-be-established National Ebola Training and Education Center, composed of experts from health care facilities that have safely and successfully cared for patients with Ebola in the U.S., and funded by ASPR and the Centers for Disease Control and Prevention, to ensure clinical staff is adequately prepared and trained to safely treat patients with Ebola and other infectious diseases,
•Be able to treat pediatric patients with Ebola or other infectious diseases or partner with a neighboring facility to do so, and,
•Be able to safely handle Ebola-contaminated or other highly contaminated infectious waste.

Proposals from these facilities were reviewed by a panel of experts from professional associations, academia, and federal agencies and were selected based upon extensive criteria published in the funding opportunity announcement released in February.

To be eligible for consideration as an Ebola and other special pathogen treatment center, facilities also had to be assessed by a Rapid Ebola Preparedness team led by the CDC prior to Feb. 20, 2015.

The Department is working with state health officials and hospital executives in HHS Region IX, which includes Arizona, California, Hawaii, Nevada and the Pacific island territories and freely associated states, to identify a partner hospital awardee.

HHS is the principal federal department for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. ASPR leads HHS in preparing the nation to respond to and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security.

To learn more about the department’s efforts to protect against Ebola, visit www.cdc.gov/Ebola and for more information on the Department’s emergency preparedness and response efforts for all hazards see www.phe.gov.

Cancer center to urge increased vaccination for HPV

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Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center

In response to low national vaccination rates for the human papillomavirus (HPV), the Fred & Pamela Buffett Cancer Center has joined 68 other top cancer centers in issuing a statement urging for increased HPV vaccination for the prevention of cancer.

The institutions collectively recognize insufficient vaccination as a public health threat and call upon the nations’ physicians, parents and young adults to take advantage of this rare opportunity to prevent many types of cancer.

National Cancer Institute (NCI)-designated cancer centers joined in the effort in the spirit of President Barack Obama’s State of the Union call for a national “moonshot” to cure cancer, a collaborative effort led by Vice President Joe Biden.

“Here in Nebraska, there are about 60 new cases of cervical cancer diagnosed every year,” said Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center. “When you take into consideration that cervical cancer is preventable, it is crucial that we strongly encourage people to discuss the HPV vaccine and other screening tests, such as Pap smears, with their healthcare providers.”

Sonja Kinney, M.D., director of the division of general obstetrics and gynecology at UNMC, who sees patients at Nebraska Medicine, said the HPV vaccine is considered the standard of care for girls and boys between the ages of 9 to 26 years old.

“The main goal of this vaccine is to fight against the two high-risk HPV strains that are responsible for causing 70 percent of all cervical cancers and two low-risk HPV strains that cause 90 percent of genital warts,” Dr. Kinney said. “The vaccines are given as a series of injections that prompt the body’s immune system to make antibodies. These vaccines also provide protection against head and neck cancers and some anal cancer that may be linked to infection with the HPV virus.”

According to the Centers for Disease Control and Prevention (CDC), HPV infections are responsible for approximately 27,000 new cancer diagnoses each year in the U.S. Several vaccines are available that can prevent the majority of cervical, anal, oropharyngeal (middle throat) and other genital cancers.

Vaccination rates remain low across the U.S., with under 40 percent of girls and just over 21 percent of boys receiving the recommended three doses. Research shows there are a number of barriers to overcome to improve vaccination rates, including a lack of strong recommendations from physicians and parents not understanding that this vaccine protects against several types of cancer.

Ebola Training Center Launches New Website

NETEC is Collaboration Between Three Ebola Treatment Experts

The National Ebola Training and Education Center (NETEC) has launched its website, which is designed to help create a repository of resources for health care facilities and health departments.

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The National Ebola Training and Education Center is collaboration between Emory University, UNMC/Nebraska Medicine and Bellevue Hospital Center. Members of the NETEC faculty come from all three entities. Some of the faculty members include (left to right): Kate Boulter, Nebraska Medicine, Shelly Schwedhelm, Nebraska Medicine, Ross Wilson, MD, Bellevue Hospital, Laura Evans, MD, Bellevue Hospital, Phil Smith, MD, UNMC, Chris Kratochvil, MD, UNMC, Bruce Ribner, MD, Emory University, Nathan Link, MD, Bellevue Hospital, Jay Varkey, MD, Emory University, Marshall Lyon, MD, Emory University, Sharon Vanairsdale, Emory University, John Lowe, UNMC and Sonia Bell, Emory University

 “The website will help us push out needed information, such as background information on Ebola, some new information on MERs, and maybe other potentially significant viruses or diseases that might arise. It will serve as a forum to get information out quickly to this new infrastructure we’re developing across the United States,” said Shelly Schwedhelm, executive director, Emergency Preparedness & Infection Prevention Services at Nebraska Medicine.

The website launch is one in a series of goals for NETEC, a collaboration between Emory University, UNMC and Bellevue Hospital Center in New York City. Funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) and CDC’s Division of Healthcare Quality Promotion (DHQP), the goal of the NETEC is to increase the competency of health care and public health workers and the capability of health care facilities to deliver safe, efficient and effective care to patients with Ebola virus disease and other highly infectious disease through a nationwide and regional network for Ebola and other highly infectious diseases.

Schwedhelm praises IT professionals Dan Moser, Lee Trant, Max Thakker and Anne Faylor for their work on the new website and NETEC technology needs.

“Our next step, again with the help of our IT folks, is to link a new learning management system with the website, so people can take courses to better educate themselves as well as get continuing education credit,” Schwedhelm says. “In addition to that, our team is also developing a process to where others across the United States could actually request a site visit using a process via the website.”

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Through the five-year project period and in collaboration with ASPR, CDC, and other stakeholders, the NETEC will:
•Develop metrics to measure facility and health care worker readiness to care for patients with Ebola virus disease
•Conduct peer review and readiness assessments of regional and state Ebola treatment centers
•Create and maintain a comprehensive suite of educational materials (e.g., curricula, just-in-time training, templates, train-the-trainer modules, tools, simulations, online resources, webinars) for guidance related to care of patients with possible Ebola
•Support public health departments and health care facilities through the provision of training and technical assistance
•Conduct Ebola preparedness courses to cover the many aspects of managing a facility and/or public health jurisdiction tasked with assessing and/or treating Ebola virus disease patients

ORs Set Record for Cases Performed

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The week of Nov. 16, Perioperative Services set a record for the most cases performed in a day.

There’s never a dull moment in our operating room suites. Last month, Perioperative Services set not one, but two records in the same week. On Nov. 16, 94 cases were performed, beating the old record of 92. But it doesn’t stop there. Just three days later, the record was broken again as the perioperative team bettered the old mark as 100 cases were performed.

As you may recall from an article back in August, Perioperative Services performed 18,038 cases in FY2015, which broke the previous record of 16,182 in FY2014.

It takes a great deal of teamwork and comradery from the OR staff and surgeons. To accomplish these amazing feats, more than 400 colleagues from 11 different cost centers must work together, often resulting in long days that stretch into the evening.

Congratulations to all colleagues who made this feat a reality!

A New Lease on Life for the New Year

1-6-free-hip-and-knee-Brenda-BosticBrenda Bostic and Curtis Hartman, MD, right before Bostic’s procedure.

While many of us take for granted our daily mobility, millions of Americans are living with excruciating hip and knee pain that cripples them, their lifestyles and their ability to work or provide for themselves or their families. There are physical and psychological tolls. Most of all, they just want their lives back.

The solution is often hip and knee replacement surgery. But what happens to those individuals who desperately need new joints to minimize pain and regain mobility and can’t have access to them due to lack of insurance coverage, financial or other constraints?

Through Operation Walk USA 2015, two Nebraska Medicine patients received free joint replacements from orthopaedic surgeon, Curtis Hartman, MD. In mid-December, 59-year-old Brenda Bostic of Bellevue, Neb., and 63-year-old Randy Robins of Blair, Neb., underwent surgery at the med center. Bostic worked in receiving at Walmart most of her adult life, and was very aware of the arthritis and pain in her knee. For 20 years, she tried to minimize the discomfort with cortisone shots, frequent doctor visits and other procedures. But, in October, she thought her knee was going numb. She was rushed to the emergency department and was told she needed knee replacement surgery. When Bostic mentioned to the med center physicians that she didn’t have insurance, they recommended Operation Walk USA. She applied and was accepted.

“I was absolutely ecstatic,” says Bostic. “I want to be able to jump up and down and run along the field to support my grandchildren at their sporting events. Being a grandmother is the joy of my life.”

1-6-free-hip-and-knee-Randy_Robins_IMG_0905-690x460Randy Robins smiles with second year orthopaedic surgery resident Tyler Larson, MD, and orthopedic surgeon Curtis Hartman, MD.

Bostic, who is also legally blind, underwent a total left knee replacement on Dec. 15, under the care of Dr. Hartman. That same day, Dr. Hartman performed a left hip replacement on Robins, who enjoyed a long career at Union Pacific Railroad. Over the years, Robins has met life’s challenges head on. Twelve years ago, his youngest daughter was diagnosed with cancer. Five years ago, he came down with a rare form of cancer himself. Then, came Robins’ left hip. He’d been feeling discomfort for years, but after his recovery from cancer, the pain was excruciating.“I’m a pretty tough guy. Always have been,” says Robins. “But, the pain was so bad that I couldn’t walk.”

Given the physical nature of his work, Robins was forced to retire early. He had little insurance and was still paying off his cancer bills. His eldest daughter had read about Operation Walk USA and applied on his behalf without him knowing it.

“I’m very emotional about it,” says Robins. “I’ve been an unselfish man all my life and told my case worker that I don’t want to take an opportunity away from somebody else. I consider myself a fortunate man just to be here. I want to live again. I want to work again.”

Operation Walk USA provides all aspects of treatment – surgery, hospitalization, and pre-and post-operative care ─ at no cost to participating patients who may not qualify for government health coverage, have insurance or afford surgery on their own. Operation Walk USA takes place annually in early December to allow for greater hospital, surgeon and medical staff participation – and as a holiday gift to the patients it treats.

Team Performs First Lung Transplant

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Back in November, we announced that Nebraska Medicine has re-implemented its Lung Transplant Program after a 17-year hiatus.

Transplant team members recently performed the first lung transplant on a patient in need of this life-saving procedure. This marks the first time the procedure has been performed here since the relaunch of the program.

Our patient has requested privacy during recovery, so this is all we are able to share at this time. Learn more about our lung transplant program in this video.

Lung Transplant Program Begins at Nebraska Medicine

One of a Few Institutions Nationwide Offering All Solid Organ Transplants

Nebraska Medicine is home to one of the most reputable and well-known organ transplant programs in the country. In the decades since the first transplant in 1970, its nationally and internationally renowned specialists have performed thousands of heart, liver, kidney, pancreas and intestinal transplants. After years of planning and preparation, the organization is launching a comprehensive Lung Transplant Program. The addition makes Nebraska Medicine one of a few institutions nationwide to offer all solid organ transplants under one roof.

“We are thrilled to offer this lifesaving treatment,” says Heather Strah, MD, medical director of lung transplantation. “The addition of lung transplantation takes Nebraska Medicine’s already elite solid organ transplant program and elevates it to the highest level in the country.”

Nebraska Medicine first offered a lung transplant program in 1995, which remained in operation until 1998. The program now looks to once again shape the field of patient care, offering a multidisciplinary team of surgeons, physicians, respiratory therapists, psychologists, social workers, dietitians, nurses and others. Professionals will provide patients support from pre-evaluation to long-term follow-up care.

“A transplant program requires a large team of people pulling in the same direction,” says lung transplant surgical director Aleem Siddique, MD. “This program is the product of a great deal of hard work. It will allow us to provide world-class care to the people of Nebraska and surrounding states.”

Patients will no longer need to travel hundreds of miles for treatments of end-stage lung disease. Nebraska Medicine’s program will also assume the care of appropriate patients who received lung transplants at other institutions.

“Patients who have been transplanted far from Omaha often have a tremendous burden on them,” says Dr. Strah. “The time and financial resources required to receive follow-up care can be astonishing. With our new program, patients will have expert care close to home while ensuring superior care coordination with their transplant center. In addition, patients who were too ill to travel and receive a transplant may now be candidates locally.”

Nebraska Medicine’s Lung Transplant Program will offer single lung, double lung and heart-lung transplants. Although the transplant process is very unpredictable, clinicians hope to evaluate 20-30 patients and transplant 10 patients in the first year. Some diseases that may require a lung transplant include cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary hypertension and many other chronic lung diseases.

“Patients who survive their first year after transplant are typically expected to survive seven or eight years,” says Dr. Strah. “But, there are lots of patients I follow who were transplanted 10, 15, 20 years ago and are still enjoying relatively good health. That’s what we want for everyone. We want nothing more than to provide the best treatment possible for those who walk through our doors.”

Along with extraordinary patient care, the program will provide lung education, research and innovation. Clinicians will also work to promote the importance of organ donation.

“Nationally, it’s estimated that 18 people die every day while waiting for organ transplants,” says Dr. Siddique. “A single donor may save up to eight lives. For the donor or their family, it’s an opportunity for altruism that may be deeply rewarding.”

To register as an organ donor, visit www.donatelifenebraska.com. To learn more about the Lung Transplant Program at Nebraska Medicine, visit NebraskaMed.com/Transplant.

 

Experimental treatment regimen effective against HIV

University of Rochester public relations

Gend0421UNMC’s Howard Gendelman, M.D.

Protease inhibitors are a class of antiviral drugs that are commonly used to treat HIV, the virus that causes AIDS. Scientists at UNMC designed a new delivery system for these drugs that, when coupled with a drug developed at the University of Rochester School of Medicine and Dentistry, rid immune cells of HIV and kept the virus in check for long periods.

The results appear in the journal Nanomedicine: Nanotechnology, Biology and Medicine. While current HIV treatments involve pills that are taken daily, the new regimens’ long-lasting effects suggest that HIV treatment could be administered perhaps once or twice per year.

Howard Gendelman, M.D., professor and chair of the UNMC Department of Pharmacology and Experimental Neuroscience, designed the investigational drug delivery system, a so-called “nanoformulated” protease inhibitor.

The process

The nanoformulation process takes a drug and makes it into a crystal, like an ice cube does to water. Next, the crystal drug is placed into a fat and protein coat, similar to what is done in making a coated ice cream bar. The coating protects the drug from being degraded by the liver and removed by the kidney.

When tested together with URMC-099, a new drug discovered in the laboratory of UR scientist Harris (“Handy”) Gelbard, M.D., Ph.D., the nanoformulated protease inhibitor completely eliminated measurable quantities of HIV. URMC-099 boosted the concentration of the nanoformulated drug in immune cells and slowed the rate at which it was eliminated, thereby prolonging its therapeutic effect.

“The chemical marriage between URMC-099 and antiretroviral drug nanoformulations could increase drug longevity, improve patient compliance, and reduce general toxicities,” said Dr. Gendelman, lead study author, who has collaborated with Dr. Gelbard for 24 years. “We are excited about pursing this research for the treatment and eradication of HIV infections.”

The two therapies were tested together in laboratory experiments using human immune cells and in mice that were engineered to have a human immune system. Drs. Gendelman and Gelbard believe that the nanoformulation technology helps keep the protease inhibitor in white blood cells longer and that URMC-099 extends its lifespan even more.

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Harris Gelbard, M.D., Ph.D.

Dr. Gelbard, director of UR’s Center for Neural Development and Disease, developed URMC-099 to treat HIV-associated neurocognitive disorders or HAND, the memory loss and overall mental fog that affects half of all patients living with HIV.

He tested it with several protease inhibitors, including the nanoformulated version developed by Dr. Gendelman, as any patient prescribed URMC-099 would also be taking antiretroviral therapy. The goal was to determine whether the drugs could be safely administered together. Much to the surprise of Drs. Gelbard and Gendelman, URMC-099 increased the effectiveness of the nanoformulated drug.

“Our ultimate hope is that we’re able to create a therapy that could be given much less frequently than the daily therapy that is required today,” Dr. Gelbard said.

UNMC researcher: Top arthritis drug underused

by Tom O’Connor, UNMC public relations

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James O’Dell, M.D.

A UNMC rheumatologist revealed study results at a major national conference earlier this month which showed that physicians are underutilizing methotrexate, the leading drug for rheumatoid arthritis (RA), or not keeping patients on the drug long enough before switching them to more expensive biologic drug options.

James O’Dell, M.D., Bruce Professor of Internal Medicine and chief of the UNMC divisions of rheumatology and immunology, delivered the message at the annual meeting of the American College of Rheumatology and the Association of Rheumatology Health Professionals in San Francisco.

Study results

To better understand how methotrexate is utilized for RA treatment in the United States, Dr. O’Dell’s research team performed an exhaustive review of anonymous claims data on 274 million patients, representing 92 percent of all prescription drugs written in the U.S. The claims data was produced by Symphony Health Solutions.

From this data, researchers were able to follow the treatment course of 35,640 RA patients between 2009 and 2014. The key findings were:

  • 15,599 (43.8 percent) continued treatment with oral methotrexate.
  • 17,528 (49.2 percent) added or switched to a biologic treatment.
  • A biologic was added at a median of 170 days and 41.5 percent of patients added a biologic agent within 90 days of the initiation of oral methotrexate.
  • Only about 7 percent of patients followed were switched from oral to subcutaneous administration of methotrexate.

“There are some major concerns here,” Dr. O’Dell said. “It shows that we’re not doing all we should with methotrexate, our No. 1 therapy for rheumatoid arthritis.”
Methotrexate is the anchor drug for a class of drugs known as disease-modifying anti-rheumatic drugs (DMARDs). The DMARDS are much less expensive than the other class of drugs used to treat RA called biologics. Previous studies have shown that the DMARDs produce the same clinical benefits in the majority of RA patients as the biological treatment.

If oral methotrexate is not producing the desired results, Dr. O’Dell said the next step should be to try patients on subcutaneous methotrexate at a higher dose.

“What we found in patients who made a treatment change was that 87 percent added a biologic instead of trying subcutaneous methotrexate,” he said. “Patients switched to biologics too quickly – 41 percent switched in three months or less.”

Dr. O’Dell said switching to subcutaneous methotrexate can prevent the need for – or significantly extend the time to – a biologic.

The study found that 72 percent of patients who switched from oral to subcutaneous methotrexate stayed on this treatment for 5 years. The other 28 percent eventually needed a biologic, at a median of 289 days on subcutaneous methotrexate.

“The bottom line,” Dr. O’Dell said, “is that more appropriate optimization of methotrexate could lead to better control of RA and produce significant cost savings. Oral methotrexate is underdosed in clinical practice, and subcutaneous methotrexate is underutilized.”

Dr. O’Dell hopes to submit his research findings to a leading scientific journal in the near future.

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