Clinical

Grouping patients into clusters based on shared characteristics, such as disease control and general health, may be helpful in understanding and predicting clinical outcomes in patients with rheumatoid arthritis (RA), according to an abstract presented at the 2019 ACR/ARP Annual Meeting, held November 8-13 in Atlanta, Georgia.

Nondrug therapies that might have been dismissed 30 years ago are now the sorts of treatments physicians are turning to instead of overused treatments like surgical procedures, opioids, and injections, said Daniel Clauw, MD, professor of anesthesiology, medicine (rheumatology), and psychiatry; director of translational research; and director of the Center for Chronic Pain and Fatigue Research.

Disease activity assessments can help physicians treat to targets, but in some areas those targets have not been set yet, said Yusuf Yazici, MD, clinical associate professor in the Department of Medicine at NYU Langone Health.

This year has been an exciting time for rheumatologists with impressive clinical trial results and promising outcomes for patients, said Susan Manzi, MD, MPH, codirector of the Lupus Center of Excellence and chair of the Department of Medicine of West Penn Allegheny Health System, during a session at the American College of Rheumatology annual meeting in Atlanta, Georgia.

Patients with diabetes who participated in a program of group medical visits (GMVs) and intensive weight management showed improvements in glycemic control, according to a study published in JAMA Internal Medicine.

Researchers have identified complement genes that appear to play a role in vision loss associated with multiple sclerosis (MS), and this finding could help researchers monitor and predict the progression and severity of MS, according to a study published in Brain.

A majority of patients with acute graft-versus-host disease (GVHD), but not all, have significant responses to the addition of ruxolitinib, said David Snyder, MD, associate chair of the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope.

Approximately 4% of the total world population is affected by a rare disease at any given time, according to new research on 3585 rare diseases.

New trials are looking at what could be the next therapy or one that layers on top of present therapies to treat lung diseases, said Lisa Lancaster, MD, assistant professor of medicine at Vanderbilt Health.

This week, the top managed care stories included a report from the FDA considering how to avoid drug shortages; a white paper finds rising comfort with telehealth even as use of digital health tools stagnates; data show a spike in the number of uninsured children.

Prithviraj Bose, MD, of MD Anderson Cancer Center discusses the risk of patients being treated with JAK inhibitors developing non-Hodgkin lymphoma.

Although the number of people with nonalcoholic fatty liver disease, which progresses to nonalcoholic steatohepatitis (NASH), is growing, the health system is still trying to get a handle on which patients to target and how to identify them before the first treatments come to market, explained panelists during a session at AMCP Nexus 2019.

Here are the top 5 articles for the month of October.

The lack of FDA approvals for the treatment of nonalcoholic steatohepatitis (NASH) and safety concerns surrounding 2 recommended treatments contribute to the barriers blocking effective progress, said Karen Watkins, PharmD, pharmacist for emerging therapeutics strategy, MedImpact Healthcare Systems.

As the number of disease-modifying therapies available for multiple sclerosis increases, patients and physicians can struggle to identify the right one for the right patient, highlighting the need for a patient decision aid.

Increased competition is making its way into the specialty drug market, affecting orphan conditions, cancer types, and even common specialty conditions, which is presenting some cost savings opportunities, explained Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts, who presented on the specialty pharmaceutical pipeline during her regular session at AMCP Nexus 2019.

Value needs to be considered early in the development life cycle of a therapy and should be continued throughout, even into the postlaunch space using real-world studies, according to a presentation on value-based services and their life cycles at the AMCP Nexus 2019 meeting.

As the number of high-cost orphan drugs and gene and cell therapies continues to grow, there will be a greater need for alternative payment models to help figure out the best way to pay for these treatments.

Accountable care organizations (ACOs) face a learning curve before they start achieving savings. David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner ACO was able to find success and how other ACOs can get over the learning curve to achieve savings.

The local community doctor has an important role in recognizing, diagnosing, and managing myelofibrosis, said Naveen Pemmaraju, MD, associate professor in the Department of Leukemia at MD Anderson Cancer Center.

Unlike many other cancer rates that have been on the decline, liver cancer rates for new liver and intrahepatic bile duct cancer cases have been rising. This October, which is Liver Cancer Awareness Month, Global Liver Institute is joining with more than 30 other leading health and medical organizations, to issue a global call-to-action to increase the 5-year survival rates for patients with liver cancer from 18% to 36% by 2030.

Childhood conditions can have a long-lasting impact on the health of those individuals into their adulthood.

Reality seems so simple. We just open our eyes and there it is. But that doesn’t mean it is simple. Penn and Teller

Less than half of Medicare patients newly diagnosed with blood cancer are receiving treatment for their cancer shortly after diagnosis, which may be attributed to the high cost burden they face, according to a new report from Milliman commissioned by The Leukemia & Lymphoma Society.

Serum neurofilament light chain is associated with brain atrophy and disability worsening, which means it can be used as an objective surrogate of ongoing disease activity in multiple sclerosis (MS), according to research published in JAMA Neurology.

While freestanding emergency departments (EDs) can reduce wait times and reduce the burden on overcrowded EDs, they increase utilization of emergency care and local market spending.

Pairing a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor with fulvestrant significantly improved overall survival (OS) for women with hormone receptor (HR)-positive, human epidermal growth factor 2 (HER2)-negative advanced breast cancer, according to 2 abstracts presented at the European Society of Medical Oncology 2019 Congress.

Lisa Lancaster, MD, assistant professor of medicine at Vanderbilt Health, discusses how sleep apnea is a comorbidity for other lung diseases, such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease.

Data from EXPLORE, a prospective, multinational, natural history study, is used to characterize disease activity and clinical management of patients with acute hepatic porphyria (AHP) who experience recurrent attacks. The findings highlight the high unmet need for effective treatments.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.