Expert opinion

Factors that influence the initiation of biologic treatments

Find out the factors that influence the initiation of biologic treatments, such as early diagnosis with laboratory diagnostics using rheumatoid factor and anti-citrullinated protein antibodies, early referral, and the early initiation of disease-modifying antirheumatic drugs (DMARD) treatment.

Access to biologic treatment options

Learn how the arrival of tumour necrosis factor alpha inhibitor (anti-TNF) biosimilars has affected access to biologic treatment options, the initiation of treatment, and how various countries, including South Korea, Australia and European nations, have expanded their use of anti-TNF biosimilars.

Treatment cycling and switching

Gain an insight into the differences between cycling through anti-TNFs biosimilars and switching to a different mechanism of action, such as janus-kinase (JAK) inhibitors, in patients who are not responsive to anti-TNF treatment.

Treating rheumatoid arthritis with αnti-TNF biosimilars

Examine the use of anti-TNF biosimilars for the treatment of rheumatoid arthritis and learn how they currently fit into the European League Against Rheumatism (EULAR), American College of Rheumatology (ACR) and British Society for Rheumatology (BSR) guidelines^1-3.

Biomarkers for anti-TNF treatment response in rheumatoid arthritis

Explore the biomarkers used to assess anti-TNF treatment response in rheumatoid arthritis, the insights that can be gained from biomarkers in gastroenterology, and data on biomarkers and therapeutic-drug monitoring.

Therapeutic drug monitoring in rheumatology

Gain a deeper understanding of the level of therapeutic-drug monitoring in rheumatology, its potential in the future, and the pragmatic argument for changing the therapeutic principle in non-responding patients.

Diagnostic techniques in rheumatology

Learn about diagnostic techniques and imaging tools from the standard x-ray to higher sensitivity techniques like magnetic-resonance imaging (MRI) or ultrasound. Find out the use of higher sensitivity techniques in clinical practice, the difficulties of using these strategies, and the need for further validation.

Treating patients with minimal disease levels or remission

Gain insight into how to treat patients with minimal disease activity including the benefits and drawbacks of early treatment, tapering down treatment, and treatment discontinuation in patients with minimal disease activity or remission.

The causes of poor adherence

Further your knowledge of the main reasons for poor adherence and treatment abandonment, and approaches that could help alleviate this problem, such as good communication and becoming part of support groups.

Methods for improving adherence

Get to know the help healthcare professionals (HCP) and manufacturers already provide, and the kinds of changes manufacturers could make that would be beneficial to patients abandoning treatment or with poor adherence, including the need for a more general view of the disease and treatment.

Modifying treatment regimens

Learn how to treat patients with poor adherence. Discover the need for deep discussions with the patient and advise how continuing to take the therapeutic as described is important.

The impact of rheumatoid arthritis on patients

Discover how patients are personally impacted by rheumatoid arthritis through loss of physical function, being unable to work, and more. Learn about the impact of coronavirus disease 2019 (COVID-19), from patient anxiety to the potential risks of immunosuppressive agents.

COVID-19 impact on αnti-TNF treatment use

Find out how COVID-19 impacted the use of treatments, such as access to medications, early in the pandemic.

The impact of αnti-TNF treatment on cases of COVID-19

Discover why the impact of anti-TNF treatment on cases of COVID-19 is still not well understood. Learn how the effects of autoimmune inflammatory disease treatments, including glucocorticoids and anti-CD20 antibodies, can affect COVID-19.

The risk of adverse events in COVID-19 and rheumatoid arthritis

COVID-19 infection and rheumatoid arthritis increase the risk of coagulopathies. Explore the converging risks of coagulopathies associated with rheumatoid arthritis and COVID-19, and the recommended treatment options^1-3.

What are the benefits and drawbacks of biosimilars in rheumatology?

Earlier treatment and greater access to treatment are important for alleviating disease burden. Expand your knowledge on the impact of biosimilars and the benefits they have in rheumatology.

What are the most significant barriers to the widespread use of biosimilars?

Is there a stigma around the use of biosimilars? Learn about the need for greater education in biologics and biosimilars, such as their validation processes and biomarkers.

Safety, efficacy, and tolerability data for biosimilars

What data are available in this rapidly growing treatment landscape? Gain a deeper understanding of the assessment of biosimilars, their safety, efficacy, and tolerability.

What evidence supports switching between originator biologics and their biosimilars?

Learn the evidence from clinical trials and real-world studies that highlight the similar clinical effect of biologics and biosimilars.

What support do you believe is necessary to minimise concerns around biosimilars?

Education of biosimilars should start at the beginning with teaching the mechanisms of biologics, how to combat the nocebo effect, and the need for support programmes for patients and HCPs.

In this section you can learn about the unmet needs in the treatment of hidradenitis suppurativa (HS), the impact of COVID-19 on HS, and the future of biosimilars in dermatology.

• View Dr Joana Cabete and Professor Tiago Torres highlight the use of tumour necrosis factor alpha inhibitor (anti-TNF) biosimilars in hidradenitis suppurativa
• Learn about treatment options, the utility of anti-TNF, and treatment initiation for people with HS
• Watch short videos on treatment maintenance, the impact of COVID-19 on HS, and the future of biosimilars in dermatology

Hidradenitis suppurativa is an inflammatory skin disease characterised by painful recurrent abscesses, malodourous purulent drainage, sinus tract and fistula formation, and disfiguring scarring involving intertriginous body sites^4,5.

The burden of hidradenitis suppurativa

Hidradenitis suppurativa imposes a burden on the life of the patient. From the difficulties of treating patients to the psychological impact it can have day to day, find out how this disease adversely effects quality of life.

Unmet needs in hidradenitis suppurativa

There has been an explosion of research in the last few years on hidradenitis suppurativa. Gain a deeper understanding of the unmet needs of this previously poorly understood disease, including a vicious circle of inadequate treatment and the difficulties of accessing care.

Treatment options for hidradenitis suppurativa

The stage of the disease determines the choice of treatment for hidradenitis suppurativa. Explore the treatment pathway of this disease with advice for patients, use of antibiotics such as tetracyclines, clindamycin and rifampicin, as well as adjuvant therapies and biological treatments.

αnti-TNF treatment for hidradenitis suppurativa

Further your knowledge on the use of adalimumab in the treatment of hidradenitis suppurativa, the potential for off-label medications such as infliximab and ustekinumab, and clinical trials looking at the efficacy of guselkumab and secukinumab in this disease.

Long-term efficacy of adalimumab for hidradenitis suppurativa

Study the results of the PIONEER I and II studies, which evaluated the efficacy of adalimumab at twelve weeks, as well as the results of an open-label extended period study that assessed the use of adalimumab in the long term⁶.

Increasing options with αnti-TNF biosimilars in hidradenitis suppurativa 

Currently, adalimumab is the only approved biologic treatment for hidradenitis suppurativa⁷. Find out how biosimilars can increase access to treatment options by giving national health systems better access, introducing competition and impacting prices.

Strategies for treatment initiation in hidradenitis suppurativa

Gain an overview of treatment initiation in hidradenitis suppurativa, including how current guidelines recommend treating adult and paediatric patients⁵. Hear real-life examples of initiating treatment with adalimumab and the utility of antibiotics, corticosteroids, and methotrexate.

Managing αnti-TNF treatment failure

Get to know the steps involved in managing patients with treatment failure through the assessment of percentage reduction of inflammatory lesions and the option of dose intensification, adjuvant therapy and off-label treatments.

Therapeutic drug monitoring in hidradenitis suppurativa

Therapeutic drug monitoring in hidradenitis suppurativa patients under biological treatment can be complex, with many hospitals not providing this service. Have a look at the options available, including measuring dose from blood samples, gaining experience from inflammatory bowel disease centres, and managing without therapeutic drug monitoring.

Adverse events with COVID-19

Examine the co-morbidities that are associated with poor COVID-19 outcomes, such as smoking, obesity, and a history of cardiovascular disease. Also, learn which treatments for hidradenitis suppurativa may be associated with poor disease outcomes.

Guidance for COVID-19 and upcoming flu season

Towards the beginning of the COVID-19 pandemic, the use of immunosuppressive and immunomodulatory drugs in patients caused concern. Gain insight into the importance of continuing treatment to prevent flares, and making good decisions on a case by case basis.

How does αnti-TNF impact cases of COVID-19?

Discover how anti-TNF is involved in the “cytokine storm” of patients infected with COVID-19, the potential benefits treatments may have in preventing organ damage, and the current trial investigating anti-tumour necrosis factor for treating COVID-19.

What are the benefits and drawbacks of biosimilars in dermatology?

Biosimilars are a reality in the treatment of immune-mediated diseases. Learn how the concerns of biosimilars for the treatment of psoriasis are no longer justified, and how biosimilars can positively impact the course of the disease.

What are the significant barriers to widespread biosimilars use?

Develop your knowledge on the perceived concerns of biosimilars, the importance of communication and education in their use, and the results of a study into patient awareness of biosimilars.

Efficacy and safety data for biosimilars

Are the concerns around biosimilars hypothetical or evidence based? Get to know the efficacy and safety data of biosimilars, their approval process, and the impact of batch-to-batch variability.

What evidence supports switching between originator biologics and their biosimilars?

Is there a significant risk of immunogenicity or side effects when switching between originator biologics and their biosimilars? Expand your knowledge on the wide variety of clinical trials and real-world studies on the efficacy of switching to biosimilars.

How will the biosimilar treatment landscape evolve in the future?

Peek into the future of biosimilars for the treatment of immune-mediated diseases, from the impact of expiring patents to how advancing technologies will lead to improvements in manufacturing processes and regulatory approval.

Watch these videos to learn expert advice on treating inflammatory bowel disease with tumour necrosis factor alpha inhibitors (anti-TNF) biosimilars.

• Watch Dr Nick Kennedy describe strategies for the initiation, optimisation and maintenance of anti-TNF biosimilars for inflammatory bowel disease
• Learn about biomarkers of inflammatory bowel disease, and treatment cycling and switching
• Consider the impact of COVID-19 pandemic on patients with inflammatory bowel disease

Inflammatory bowel diseases can result in debilitating physical and psychosocial symptoms for patients, and can adversely affect society as a whole through loss of schooling, absenteeism, and health-care costs^8-11.

The impact of inflammatory bowel disease

Inflammatory bowel disease is a long-term condition that significantly impacts the lives of patients. Learn about the symptoms of the disease and the extraintestinal manifestations of symptoms. See how treatment and surgery affects patients.

Timely initiation of biologic treatments

Getting the right treatment to the right patient at the right time is essential. Find out about the importance of risk stratification, access to effective treatments, effective multidisciplinary work, and patient communication.

The impact of biosimilars on access to treatment options and initiation

See how the introduction of biosimilar anti-TNFs, such as infliximab and adalimumab, have made decisions about dose optimisation more straight forward, and have led to the use of therapies earlier in the treatment course.

Treatment cycling and switching

Examine the different cases where switching and cycling may be useful, such as cycling to another anti-TNF therapy in patients who have developed immunogenicity or switching to an agent with a different mechanism of action in patients with adequate drug levels and no improvement.

Treating inflammatory bowel disease with αnti-TNF biosimilars

Further your knowledge on the use of anti-TNF biosimilars for the treatment of inflammatory bowel disease in clinical practice and how well they fit into the British Society of Gastroenterology (BSG) guidelines⁹.

Using a step-up approach to αnti-TNF treatment

Various approaches can be taken when selecting therapies and managing patients. Learn about the types of patients that can benefit from a step-up approach to anti-TNF treatment, and the importance of assessing the individual patient, reassessment after change in treatment, limiting damage, and the dangers of undertreatment.

Biomarkers for αnti-TNF treatment response

Get to know the biomarkers for anti-TNF treatment response, such as C- reactive protein (CRP) and faecal calprotectin. Learn how therapeutic drug monitoring and anti-drug antibodies can be useful as part of a decision-making algorithm, and how genetic testing, mucosal biomarkers, and newer biomarkers like TREM1 are on the horizon.

Therapeutic drug monitoring in inflammatory bowel disease

Gastroenterology has been ahead in the use of therapeutic drug monitoring compared to other immune mediated disease areas. Hear how the PANTS study and other studies have provided data for a strong association between drug concentration and outcome both in the short and long term¹².

Reactive and proactive therapeutic drug monitoring in inflammatory bowel disease

Find out why reactive therapeutic drug monitoring is currently the standard of care for patients’ inflammatory bowel disease, and the scenarios in which proactive therapeutic drug monitoring may be useful. Learn about the studies that have provided data for the use of proactive therapeutic drug monitoring.

Diagnostic techniques for inflammatory bowel disease

Explore the variety of diagnostic techniques that are used in the assessment of inflammatory bowel disease, including colonoscopy with intubation of the terminal ileum for the lower gastrointestinal tract and cross-sectional imaging, such as magnetic-resonance imaging (MRI), or ultrasound.

Treating patients with minimal disease levels, or remission of inflammatory bowel disease

As a long-term chronic illness, it is important to follow-up patients with inflammatory bowel disease. Learn how to treat patients with minimal disease levels, including continuing effective therapies until a prolonged period of remission and negatives of discontinuing anti-TNF treatment.

The causes of treatment abandonment and poor adherence in inflammatory bowel disease

Have a look at the main reasons why patients might fail to adhere adequately to their medication, including forgetfulness, fear of side effects and a lack of understanding of negative effects. Find out the consequences of non-adherence, and the benefits of open dialogue and a good relationship with Inflammatory bowel disease nurses.

Improving treatment abandonment and adherence in inflammatory bowel disease

Gain a deeper understanding of the wide variety of strategies that exist for improving adherence in Inflammatory bowel disease patients. From education through leaflets, nursing teams and the multidisciplinary team, to apps and investigating the causes of poor adherence.

Modifying treatment regimen

Get to know the scenarios where alternative treatment regimens could positively impact patient adherence, such as patients who respond poorly to subcutaneous or intravenous therapy, or patients requiring complex multiple-daily dosing.

Inflammatory bowel disease susceptibility to COVID-19

Many patients with inflammatory bowel disease have concerns about their disease in relation to COVID-19. Get an overview of how inflammatory bowel disease impacts the risk of acquiring COVID-19 and severe outcomes.

Impact of COVID-19 on αnti-TNF treatment

Explore the guidance available from the British Society of Gastroenterology (BSG) guidelines including the necessity of optimally treating patient’s inflammatory bowel disease and continuing to use those therapies where possible throughout the pandemic⁹. Also learn about the logistical issues caused by the COVID-19 pandemic.

Impact of αnti-TNF treatment on COVID-19

Current data suggests that anti-TNF treatment is unlikely to increase the risk of severe outcomes of COVID-19. Discover how some medications may help in the secondary immune activation phase of COVID-19, and how anti-inflammatory therapy in patients with COVID-19 will need to be driven by results and clinical trials.

Risk of coagulopathies

Both COVID-19 infection and inflammatory bowel disease increase the risk of thromboembolic events. Gain an insight into risk factors for venous thromboembolism (VTE), thromboprophylaxis, post-hospital prophylaxis, and other medical therapies that may affect risk of thromboembolic disease.

Professor Thomas Dörner

Meet our expert Professor Thomas Dörner, a board certified Rheumatologist and Professor of Rheumatology and Hemostaseology at Charité University Hospitals, Berlin, Germany.

Professor Joao Goncalves

Meet our expert Professor Joao Goncalves, Director of the iMed-Research Institute for Medicines, and Professor of Immunology and Pharmachology at the University of Lisbon, Portugal.

Dr Joana Cabete

Meet our expert Dr Joana Cabete, a dermatology and venereology consultant at Santo António dos Capuchos Hospital - Centro Hospitalar de Lisboa Central, Lisbon, Portugal.

Professor Tiago Torres

Meet our expert Professor Tiago Torres, a Professor of Dermatology at the University of Porto, Portugal.

Dr Nick Kennedy

Meet our expert Dr Nick Kennedy, a Consultant Gastroenterologist at the Royal Devon and Exeter NHS Foundation Trust and Honorary Clinical Senior Lecturer at the University of Exeter Medical School, Exeter, UK.

References

1. ELAR. European League Against Rheumatism 2022 Publications. https://esor.eular.org/totara/catalog/index.php?catalog_cat_browse=79&orderbykey=text&itemstyle=narrow. Accessed September 14, 2022.
2. ACR. American College of Rheumatology 2022 Clinical Practice Guidelines. https://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines. Accessed September 14, 2022.
3. BSR. British Society for Rheumatology 2022 Guidelines. https://www.rheumatology.org.uk/practice-quality/guidelines. Accessed September 14, 2022.
4. Naik HB. Hidradenitis suppurativa introduction. Semin Cutan Med Surg. 2017;36(2):41.
5. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermotol. 2019;81(1):91–101.
6. Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, et al. Two Phase 3 Trials of Adalimumab for Hidradenitis Suppurativa. New Eng J Med. 2016;375(5):422–434.
7. FDA. HIGHLIGHTS OF PRESCRIBING INFORMATION: HUMIRA® (adalimumab). 2021. Available at: https://www.rxabbvie.com/pdf/humira.pdf.
8. Jairath V, Feagan BG. Global burden of inflammatory bowel disease. The Lancet Gastroenterol Hepatol. 2020;5(1):2–3.
9. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1–06.
10. Bernstein CN, Eliakim A, Fedail S, Fried M, Gearry R, Goh KL, et al. World gastroenterology organisation global guidelines inflammatory bowel disease: update August 2015. J Clin Gastroenterol. 2016;50:803–818.
11. Panaccione R, Steinhart AH, Bressler B, Khanna R, Marshall JK, Targownik L, et al. Canadian Association of Gastroenterology clinical practice guideline for the management of luminal Crohn’s disease. J Can Ass Gastroenterol. 2019;2(3):e1–34.
12. Kennedy NA, Heap GA, Green HD, Hamilton B, Bewshea C, Walker GJ, et al. Predictors of anti-TNF treatment failure in anti-TNF-naive patients with active luminal Crohn's disease: a prospective, multicentre, cohort study. The Lancet Gastroenterol Hepatol. 2019:341–353.