Emerging technology can help choose the right drug at the right time


Source:

Curtis JR. Personalizing rheumatology care using biomarkers and digital health strategies. Presented at the Eastern Clinical Rheumatology Congress; May. 12-15, 2022. (virtual meeting).


Disclosures: Curtis reports associations with AbbVie, Amgen, Bendcare, Bristol Myers Squibb, Corona/CorEvitas, GlaxoSmithKline, Janssen, Eli Lilly, Myriad, Novartis, Pfizer, Sanofi, Scipher and UCB.


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DESTIN, Fla. — Remotely monitoring patients using new technology could allow rheumatologists to choose the “right drug the first time,” according to data presented at the Eastern Clinical Rheumatology Congress.

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 predict which drugs will elicit the best response.


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“What we hope to do is predict the right drug for the right patient at the right time,” Jeffrey R. Curtisdoctor, told the participants. “But unfortunately we don’t have it yet.”

“We’re going to talk about predicting the future,” he said.

At this point, Curtis suggested that the word “predict” is often used incorrectly in medicine. He noted that predicting response to a drug or treatment is an inexact science that uses imperfect data to assess what may happen to a patient.

“What we hope to do is predict the right drug for the right patient at the right time,” he said. “But unfortunately we don’t have it yet.”

In rheumatology specifically, clinicians typically start with one drug and, if that doesn’t work, try another.

“The evidence is usually very weak, or the recommendations are conditional,” Curtis said.

Additionally, clinical factors are often considered only with respect to the second or third medication a rheumatologist may choose.

“What are you going to achieve?” he said. “The answer is: what the insurance company tells me to achieve.”

However, advances in technology can change this landscape.

“The goal is to get the right class of drugs right from the start,” Curtis said.

For example, the PRISM RA test can help predict a poor response to a TNF inhibitor. Curtis noted that it can be counterintuitive to have a test that predicts nonresponse as opposed to response.

“But after methotrexate fails, most rheumatologists will look for a TNF inhibitor,” he said. “We want a test that changes what you would actually do.”

As the PRISM test grows in popularity, Curtis raised the question of whether insurance companies would allow rheumatologists to make treatment choices based on these results.

“In Alabama, you can choose adalimumab [Humira, AbbVie],” he said. “If you apply for anything else, you get adalimumab, and if you appeal, you get adalimumab.”

In short, the payers direct the therapeutic choices.

“Science should drive policy, not the other way around,” Curtis said.

Additionally, Curtis argued that it is less costly for patients to be in remission than to have relapses and continued flare-ups of their disease.

“That may be the only part of the conversation a payer can care about,” he said.

Payers, in fact, may be starting to pay attention to these advances. Some forms of patient data collected through mobile technology became reimbursable “as of January of this year,” according to Curtis.

With that in mind, Curtis urged rheumatologists to take note of new approaches currently available on the market, such as devices to monitor uric acid levels for patients with gout, or “smart toilets” to gather information about stools in Crohn’s disease and colitis.

“You can measure almost anything noninvasively,” Curtis said.

However, the possibility of collecting all this information leaves room for another question: “But what does this mean?” Curtis said.

With the technology in place, it is up to clinicians to make sense of the information and use it for the clinical benefit of their patients, Curtis explained.

“If we’re forcing a patient to wear a device and collect all this data, we really need to use it,” he said. “It’s really quite disheartening if we have patients telling us all this information and then we ignore it.”

Curtis urged rheumatologists not just to embrace new technologies, but to tailor 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 score.”

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