Too Little Too Late: Effect of Poor Access to Biologics for Patients with Rheumatoid Arthritis

Johnson, Bryce V.; Bahce-Altuntas, Asena

doi:10.3899/jrheum.171148

Cited by 4 publications

(1 citation statement)

References 12 publications

(9 reference statements)

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“…Previous studies have shown that sociodemographic factors can affect multiple aspects of care in RA, including mortality and disability, disease activity, prevalence of comorbidities, patient‐reported outcomes, access to treatment/health services, treatment preferences and medication adherence, health literacy, and trust in providers . A better understanding of the effects of sociodemographic factors on the validity of PROMIS physical function measures will determine their generalizability across diverse communities.…”

Section: Introductionmentioning

confidence: 99%

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

Izadi

Katz

Schmajuk

et al. 2019

Arthritis Care & Research

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Section: Introductionmentioning

confidence: 99%

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

Izadi

Katz

Schmajuk

et al. 2019

Arthritis Care & Research

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Partnering with people living with rheumatoid arthritis for care of their hands: Four case reports using relative motion orthoses

Feehan

Hoens

Howell³

2023

Journal of Hand Therapy

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Excessive Pricing Causes Poor Access to Biologics

Boers

2018

J Rheumatol

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I read with interest the editorial 1 by Johnson and Bahçe-Altuntaş, commenting on an article in The Journal 2. The latter article documented no decrease in rates of joint replacement in rheumatoid arthritis (RA) in New Zealand, while rates increased for osteoarthritis 2. Even though the rates of joint replacement in different countries form a mixed message, the editorialists made the case that patients in New Zealand have been deprived of good care because access to biologics was so limited. They contrast this with access in other countries, including the United States, and with American College of Rheumatology and European League Against Rheumatism (EULAR) guidelines, to opine on optimal government policy regarding access. Although undoubtedly well-intentioned, the editorial reads like an advertisement for biologics: its conclusion is "It is clear from this article that access to biologics for patients with RA after the presence of erosions is too little too late." The authors misquote the EULAR guidelines, suggesting that they "recommend starting b[iologic] DMARD [disease-modifying antirheumatic drug] immediately after diagnosis or after traditional DMARD failure": in fact, the recommendation is to start only after failure 3. Quoting a study from Sweden 4 , they also appear to suggest that the effect of biologic treatment on joint replacement rates (if any) offsets the costs associated with biologics use. Even broader, they appear to suggest that biologics therapy is cost-effective ("Biologic agents, despite their costs, can lower the disease burden for society"). I say "appear to suggest" because the above sentence could have been crafted by a marketing department, in the way that it subtly fudges the issue: it does not say "cost" but "disease burden." In reality, this Swedish study, and another that was reported last year in The Journal 5 , and in fact all studies not commissioned by industry, make it abundantly clear that at current price levels, biologics can never be cost-effective. The stark reality is that the pharmaceutical industry prices these drugs at a level that the market will bear (with yearly increases if possible); this policy threatens to bankrupt society and destroy insurance systems based on solidarity. It is ironic that 2 authors from the United States aim to educate non-US governments on their policy for drug access: even though biologics were marketed "a decade earlier" in the United States than in New Zealand 1 , and the United States has no "draconian policy" to limit access, many people in the United States have limited health insurance coverage, and currently 9% have no coverage at all 6. The political party and president currently in power are working diligently to sabotage efforts at improving this. To be fair, the editorial also states: "The advent of biosimilars opens a brave new world of opportunity to reduce the cost of access to biological DMARD." 1 But overall, the editorial closely reflects the position of rheuma-tologists (including me) to date: our specialty has profited im...

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Too Little Too Late: Effect of Poor Access to Biologics for Patients with Rheumatoid Arthritis

Cited by 4 publications

References 12 publications

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

Partnering with people living with rheumatoid arthritis for care of their hands: Four case reports using relative motion orthoses

Excessive Pricing Causes Poor Access to Biologics

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