Unmet need in rheumatology: reports from the Targeted Therapies meeting 2018

Abstract

To develop a comprehensive listing of the greatest unmet scientific and clinical needs in rheumatology. The 20th annual international Targeted Therapies meeting brought more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. During the meeting, breakout sessions were convened, consisting of five disease-specific groups with 20–30 experts assigned to each group based on expertise. Specific groups included rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus, connective tissue diseases and a basic science immunology group spanning all of these clinical domains. In each group, experts were asked to consider recent accomplishments within their clinical domain in the last year and update the unmet needs in three categorical areas: basic/translational science, clinical science and therapeutic development, and clinical care. While progress was noted among some of previously identified needs, both new needs were identified and themes from prior meetings were re-iterated: the need for better understanding the heterogeneity within each disease, and for identifying preclinical states of disease allowing treatment and prevention of disease in those at risk, and the elusive ability to cure disease. Within the clinical care realm, improved comorbidity management and patient-centred care continue to be unmet needs, and the need for new and affordable therapeutics was highlighted. Unmet needs for new and accessible targeted therapies, disease prevention and ultimately cure remain a priority in rheumatology.

Unmet need in rheumatology: reports from the Targeted Therapies meeting 2019

“…In 2018, the spondyloarthritis discussion group identified a variety of unmet needs which included: understanding the relationship of peripheral disease to axial disease; early recognition and diagnosis of disease; understanding the causes/relationship of extra-articular disease including bowel and eye disease to the joint disease; improved imaging technologies and interpretation; development of biomarkers for prognosis and choice of therapy; a wider choice of biological therapies; an ability to improve prognosis (disease modifying treatment); direct comparison among TNF inhibitors with regard to efficacy and safety; more frequent disease remission; improved referral to a rheumatologist and international collaboration 21…”

Can the development of psoriatic arthritis be prevented in patients with psoriasis?

“…Следует особо подчеркнуть, что у пациентов с псориазом субклиническое поражение «синовио-энтезиальных» тканей развивается задолго до появления первых клинических признаков артрита [19]. [22,24], системной склеродермии у пациентов с изолированным феноменом Рейно [25] и тромбозов у пациентов, в сыворотках которых обнаруживаются антитела к фосфолипидам [25]. Следует подчеркнуть, что, поскольку годовая частота развития ПсА при псориазе составляет около 3% [26], для решения этой проблемы необходимо или включить в исследования очень большое число пациентов с псориазом, или идентифицировать клинические и лабораторные биомаркеры, позволяющие сформировать группы «высокого риска» развития ПсА при псориазе.…”

The unmet need in rheumatology: Reports from the targeted therapies meeting 2017

“…In 2018, the spondyloarthritis discussion group identified a variety of unmet needs which included: understanding the relationship of peripheral disease to axial disease; early recognition and diagnosis of disease; understanding the causes/relationship of extra-articular disease including bowel and eye disease to the joint disease; improved imaging technologies and interpretation; development of biomarkers for prognosis and choice of therapy; a wider choice of biological therapies; an ability to improve prognosis (disease modifying treatment); direct comparison among TNF inhibitors with regard to efficacy and safety; more frequent disease remission; improved referral to a rheumatologist and international collaboration. 21 Although this list is comprehensive, additional themes were identified as most important. First, the need to better understand the microbiome is paramount.…”