Selective Costimulation Modulators: Addressing Unmet Needs in Rheumatoid Arthritis Management

In accordance with ACCME Standards for Commercial Support of Continuing Medical Education and the Health Science Center for Continuing Medical Education Disclosure Policy for CME Activities, faculty members have been asked to disclose any relationship they may have with commercial supporters of this CME activity or with companies providing drugs, medical equipment, etc, that may have relevance to the content of their presentations. Such disclosure is intended to provide participants with sufficient information to evaluate whether any given presentation has been influenced by the faculty's relationship(s) or financial interests with said companies.

The following faculty have reported receiving something of value from the commercial supporter(s) of this activity or from a corporate organization whose product(s) may have relevance to the content of their presentations:

Author(s)

Paul Emery, MA, MD, FRCP

Professor, Academic Section of Musculoskeletal Disease, University of Leeds; Clinical Director, Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, England

Disclosures

Disclosure: Paul Emery, MD, MA, has disclosed that he has received an honorarium from the Health Science Center for Continuing Medical Education in conjunction with this supplement. Dr. Emery has also disclosed that he is an investigator and expert speaker for Bristol-Myers Squibb; Consultant: Bristol-Myers Squibb Company; Grants/research support: Bristol-Myers Squibb Company; Honoraria: Bristol-Myers Squibb Company.

John C. Davis, Jr, MD, MPH, FACR, FACP

Assistant Professor of Medicine; Associate Director, Clinical Trials Center; Director, Lupus Clinic, University of California, San Francisco

Disclosures

Disclosure: John C. Davis, Jr., MD, MPH, FACR, FACP, has disclosed that he has received an honorarium from the Health Science Center for Continuing Medical Education in conjunction with this supplement; Consultant: Bristol-Myers Squibb Company; Honoraria: Bristol-Myers Squibb Company.

Lars Klareskog, MD, PhD

Professor; Head, Department of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden

Disclosures

Disclosure: Lars Klareskog, MD, PhD, has disclosed that he has received an honorarium from the Health Science Center for Continuing Medical Education in conjunction with this supplement; Consultant: Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb Company, Celltech, Wyeth; Grants/Research Support: Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb Company, Schering-Plough, Wyeth; Honoraria: Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb Company, Centocor, Wyeth.

Rene R. Westhovens, MD, PhD

Professor, Rheumatology Section, Catholic University of Leuven, Leuven, Belgium; Head, Department of Rheumatology Clinic, University Hospital Leuven, Leuven, Belgium

Disclosures

Disclosure: Rene Westhovens, MD, PhD, has disclosed that he is a consultant for Bristol-Myers Squibb Company and Schering-Plough Belgium. Dr. Westhovens has also disclosed that he has received an honorarium from the Health Science Center for Continuing Medical Education in conjunction with this supplement; Consultant: Bristol-Myers Squibb Company, Novartis, Schering-Plough Belgium; Speaker's Bureau: Bristol-Myers Squibb Company.

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Unmet Needs in the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that causes progressive joint destruction, pain, and significant physical limitation. The course of RA is characterized by alternating remissions and exacerbations, and long-term treatment is usually required to prevent disease flares.^[1]

Studies that have examined the prevalence of RA among twin pairs have consistently found that the concordance rate of RA is approximately 12% to 15% among monozygotic twins and approximately 3.5% among dizygotic twins.^[2,3] This suggests that both genetic and environmental factors are important in the pathogenesis of RA.

It is estimated that more than 2 million people in the United States have RA. Epidemiologic studies conducted in Europe and the United States have generally reported prevalence estimates of .5% to 1% among adults, although the prevalence of RA is considerably higher than this in some populations (eg, as high as 5% to 8% among Chippewa and Pima American Indian tribes).^[1] The age of onset is variable, but the mean age at first symptoms of RA is typically between 50 and 60 years. The disease results in an average decrease in life expectancy of approximately 5-10 years.^[4,5] RA is more common in women than in men.^[6,7]

Synthetic disease-modifying antirheumatic drugs (DMARDs) have long been used to slow the progression of joint destruction in patients with RA. However, these agents fail to significantly improve the course of RA in a substantial number of patients, and they are associated with considerable toxicity. During the last decade, a number of biological DMARDs, specifically agents that target inflammatory cytokines, have entered clinical practice. These agents are effective for the treatment of RA and are generally well tolerated. However, many patients still do not respond adequately to treatment with these available medications, even when they are used in combination with synthetic DMARDs.^[8] Stopping treatment with these drugs generally leads to disease flares.^[9] Thus, there remains a significant unmet need for new, clinically efficacious therapies for RA.