Cost evolution of biological drugs in rheumatoid arthritis patients in a tertiary hospital: Influential factors on price

Action of Tofacitinib in a Rat Model of Synovitis

Purpose: To evaluate effects and mechanism of tofacitinib in treatment of rheumatoid arthritis (RA) model rats. Materials and Methods: Dividing 27 rats into 3 groups: NC (normal control), Model (RA model) and Tofacitinib (RA model rats treated with tofacitinib) groups. Observation joint swelling and articular synovium pathology by HE staining, IL-1β, IL-6, IL-10 and TNF-α levels by ELISA assay, JAK2, STAT3 and NF-κB(p65) proteins by IHC and WB assay. Results: Compared with NC group, joint swelling, histopathological score IL-1β, IL-6, IL-10 and TNF-α significantly deteriorated (P < 0.001, respectively); by IHC and WB assay, JAK2, STAT3 and NF-κB(p65) proteins expression were significantly up-regulation in joint synovial tissue in model group (P < 0.001, respectively). With tofacitinib supplement, joint swelling, histopathological score IL-1β, IL-6, IL-10 and TNF-α significantly improved (P < 0.001, respectively); by IHC and WB assay, JAK2, STAT3 and NF-κB(p65) proteins expression significantly down-regulation in joint synovial tissue in Tofacitinib group (P < 0.001, respectively). Conclusion: Tofacitinib could improve RA via regulation JAK2/STAT3/NF-κB(p65) pathway in vivo study.

Treatment strategies in axial spondyloarthritis: what, when and how?

There have been major advances in the management of axial spondyloarthritis (axSpA) with the introduction of effective biologic agents targeting TNF and IL-17A. Clinicians now have more choice but, despite treatment recommendations, are still faced with significant uncertainty when deciding on the optimal treatment strategy for an individual patient in clinical practice. Management of axSpA typically requires both non-pharmacological and pharmacological interventions. NSAIDs remain the first line drug therapies for axSpA with proven efficacy for symptomatic management but uncertainty remains regarding their optimal long-term use relating to radiographic progression and safety in axSpA. To-date there are no head-to-head trials of biologics in axSpA. Clinicians need to consider other factors, including extra-articular manifestations, comorbidities, safety and radiographic progression when deciding on which biologic to recommend for an individual patient. This article will explore the evidence relating to these factors and highlight areas of unmet need.

One-year direct costs of biological therapy in rheumatoid arthritis and its predictive factors: data from the Moroccan RBSMR registry

The aim of the study was to estimate the annual direct costs of biological therapies in rheumatoid arthritis (RA), and to establish possible factors associated with those costs. The main data source was the Moroccan registry of biological therapies in rheumatic diseases (RBSMR Registry). We included patients with available 1-year data. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Differences in costs across groups were tested by Mann-Whitney and Kruskal-Wallis tests. Correlations analysis was performed in search of factors associated with high costs. We included 197 rheumatoid arthritis patients. The mean age was 52.3 ± 11 years, with female predominance 86.8%. Receiving one of the following therapies: rituximab (n = 132), tocilizumab (n = 37), or TNF-blockers (n = 28). Median one-year direct costs per patient were €1665 [€1472-€9879]. The total annual direct costs were € 978,494. Rituximab, constituted 25.7% of the total annual budget. TNF-blockers and tocilizumab represented 27.3% and 47% of this overall budget, respectively. Although the costs were not significantly different in terms of gender or level of study, the insurance type significantly affected the cost estimation. A positive correlation was found between the annual direct cost and body mass index (r = 0.15, p = 0.04). In Morocco, a developing country, the annual direct costs of biological therapy are high. Our results may contribute to the development of strategies for better governance of these costs.