Curtis JR. Personalizing Rheumatology Care using Biomarkers & Digital Health Strategies. Presented at The Congress of Clinical Rheumatology East; May. 12-15, 2022. (virtual meeting).
Disclosures: Curtis reported on associations with AbbVie, Amgen, Bendcare, Bristol Myers Squibb, Coronna/CorEvitas, GlaxoSmithKline, Janssen, Eli Lilly, Myriad, Novartis, Pfizer, Sanofi, Scipher and UCB.
DESTIN, Fla. – Remote patient monitoring using novel technology could enable rheumatologists to choose the “right treatment out of the gate,” according to data presented by the Congress of Clinical Rheumatology East.
Jeffrey R. Curtis, MD, of the University of Alabama at Birmingham, noted that a wide range of technological advances, from clinical informatics to drug selection using patient-generated data, may allow rheumatologists to better see which medications will get the best response.
“We’re going to talk about predicting the future,” he said.
At that point, Curtis suggests that the word “prophecy” is often used incorrectly in medicine. He noted that predicting response to a drug or treatment is an inaccurate science that uses incomplete data to assess what might happen to a patient.
“What we hope to do is to predict the right medication for the right patient at the right time,” he said. “But sadly, we don’t have that yet.”
In rheumatology in particular, clinicians often start one medication, and if that doesn’t work, try another.
“The evidence is often very low, or the recommendations are conditional,” Curtis said.
In addition, clinical factors are often considered regarding the second or third treatment that a rheumatologist may choose.
“What can you get?” as he. “The answer is: What does the insurance company say I can achieve.”
However, technological advances may change this landscape.
“The goal is to get the right kind of drug straight out the gate,” Curtis said.
For example, the PRISM RA test can help predict an adverse response to a TNF inhibitor. Curtis notes that it can be counterproductive to have a test that predicts no response as opposed to the answer.
“But after methotrexate fails, most rheumatologists come up with a TNF inhibitor,” he said. “We want an attempt to change what you really do.”
While the PRISM trial has gained more widespread adoption, Curtis raises the question of whether insurance companies will allow rheumatologists to make treatment options based on such findings.
“In Alabama, you can choose adalimumab [Humira, AbbVie]”he said.” If you apply for something else, you get adalimumab, and if you appeal, you get adalimumab. “
In short, payers manage treatment options.
“Science should lead policy, and not the other way around,” Curtis said.
In addition, Curtis argues that it is cheaper for patients to lose remission than to have a persistent recurrence and flare-up of their disease.
“Maybe that’s the only part of the conversation that can get the attention of a payer,” he said.
Payers, in fact, may be starting to notice such developments. Some forms of patient data collected through mobile technology will be exchanged “in January this year,” according to Curtis.
With this in mind, Curtis urged rheumatologists to pay attention to new methods currently available on the market, such as devices to monitor uric acid levels for patients with gout, or “smart toilet ”to collect stool information on Crohn’s disease and colitis.
“You can measure almost anything non -invasive,” Curtis said.
However, the ability to collect all this information precedes another question: “But what does it mean?” said Curtis.
With technology in place, it’s up to clinicians to understand the information and use it to clinical benefit for their patients, Curtis argues.
“If we’re going to make a patient wear a device and collect all this data from them, we really have to use it,” he said. “It would be discouraging when we had patients telling us all this information and then we didn’t ignore it.”
Curtis urges rheumatologists not only to adopt new technologies, but to adapt their use to factors that are important to patients, such as sleep or fatigue.
“It gives the patient a voice,” he said. “It doesn’t reduce them to a CDAI mark.”