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Expert Guidance on Monotherapy vs. Combination Therapy in RA Management

Advancing the Management of Rheumatoid Arthritis: Applying Evidence-Based Strategies to Improve Patient Outcomes
Launch Date:
December 14, 2015
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Rheumatologists; internal medicine physicians with a secondary in rheumatology; physician assistants (PAs); nurse practitioners (NPs); and nurses in rheumatology

Relevant Terms:

Rheumatoid arthritis; biologic therapy; methotrexate; biologic monotherapy

Jonathan Kay, MD

Jonathan Kay, MD
Professor of Medicine
University of Massachusetts Medical School
Director of Clinical Research
Division of Rheumatology UMass Memorial Medical Center
Worcester, Massachusetts

Jonathan Kay, MD, received his medical degree from the University of California School of Medicine in San Francisco, California. He then completed an internship and residency at the Hospital of the University of Pennsylvania in Philadelphia and fellowships in rheumatology and immunology at The Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. Dr. Kay is Professor of Medicine at the University of Massachusetts Medical School and a Physician at UMass Memorial Medical Center in Worcester, where he directs Clinical Research in the Division of Rheumatology. Dr. Kay is a Fellow of the American College of Rheumatology and of the American College of Physicians. He is an ad hoc reviewer for many journals and a member of the editorial boards of Best Practice and Research Clinical Rheumatology, Journal of Clinical Rheumatology, and RMD Open.

Dr. Kay’s clinical interests span the spectrum of rheumatic diseases, with special interest in rheumatoid arthritis, spondyloarthropathies, and other forms of inflammatory arthritis. He was a member of the group that developed the 2010 ACR/EULAR Diagnostic and Classification Criteria for Rheumatoid Arthritis. He chairs the Rheumatology Working Group and is a member of the Internal Medicine and Musculoskeletal Topic Advisory Groups for the World Health Organization in its Revision of the International Classification of Diseases (ICD)-11.

Gregg Silverman, MD

Gregg Silverman, MD
Professor of Medicine and Pathology Director of the B Cell Immunobiology Laboratory
New York University School of Medicine
New York, NY

Dr. Silverman is Professor of Medicine and Pathology, and Director of the B Cell Immunobiology Laboratory, at the NYU School of Medicine.  He leads a well-funded laboratory program that focus on the pathogenetic and protective roles of B cells in autoimmunity and inflammatory diseases. Dr. Silverman is a member of the American Society for Clinical Investigation, the Henry Kunkel Society, and the American College of Rheumatology Committee on Research. At NYU, Dr. Silverman serves as a lecturer in multiple courses for the Sackler Gruate School, the Immunology Training Program and the NYU Department of Medicine.

Jeff Curtis, MD

Jeffrey R. Curtis, MD, MS MPH
Professor of Medicine
William J. Koopman Endowed Professor in Rheumatology and Immunology
Director, UAB Arthritis Clinical Intervention Program
Co-Director, UAB Center for Education and Research on Therapeutics (CERTS)
Co-Director, UAB PharmacoEpidEmiology and phaRmcoeconomics (PEER) Unit
University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
Birmingham, Alabama

Dr. Curtis is a Professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham (UAB). He is the Co-Director of the UAB Center for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders, which has a major emphasis on evaluating the safety and comparative effectiveness of medications for rheumatic diseases. Additionally, as the Director of the UAB Arthritis Clinical Intervention Program, he leads the clinical trials unit for the rheumatology division at UAB, with a particular focus on rheumatoid arthritis (RA) and psoriatic arthritis (PsA). He is the Co-Director of the UAB Pharmacoepidemiology and Pharmacoeconomics Research (PEER) Unit. PEER uses multiple large data sources to study comparative effectiveness questions across multiple chronic diseases. These data sources include national administrative data from Medicare and commercial health plans, electronic health record data, and large registries. He has been awarded the William J. Koopman Endowed Professorship in Rheumatology and Immunology. He was a member of the ACR’s task force to update recommendations for the management of glucocorticoid induced osteoporosis (GIOP). He also served on the ASBMR Task Force on Atypical Subtrochanteric and Diaphyseal Fractures.
Dr. Curtis is a member of the American College of Rheumatology (ACR), the International Society for Pharmacoepidemiology (ISPE), and the American Society of Bone and Mineral Research (ASBMR). He has been on the editorial board for Arthritis & Rheumatism, Pharmacoepidemiology and Drug Safety (PDS) and Arthritis Care and Research (AC&R). He has authored more than 250 original peer-reviewed manuscripts.
1. Identify the appropriate use of newer therapies for RA management based on recent trial data
2. Consider all approved first-line therapy options for patients with RA
3. Review the results of the clinical trials of biologic agents used as monotherapy
4. Integrate biologic monotherapy into the list of therapeutic options for patients with RA

Presented by:
Jointly provided by:

This activity is supported by educational grants from: Genentech Inc, Eli Lilly and Company, and Pfizer Inc.

Method of Participation
Participants should review the activity information, watch the videos in their entirety, and complete the online post-test and evaluation. Upon successful completion of the online test and evaluation form, you will be directed to a Web page that will allow you to print your certificate of credit.

Target Audience
This activity has been designed for rheumatologists, primary care physicians, nurse practitioners, nurses, physician assistants, pharmacists, and other health care providers who treat patients with rheumatic diseases.

Statement of Need
In the absence of a cure for rheumatoid arthritis (RA), the goals of therapy for all patients remain reduction of signs and symptoms, prevention of radiologic progression and subsequent disability, and improved quality of life. Available therapies include TNF alpha inhibitors, the interleukin-1 receptor antagonist anakinra, the selective T cell costimulation modulator abatacept, the CD20-directed cytolytic antibody rituximab, and the interleukin-6 receptor antibody tocilizumab, and the Janus kinase inhibitor tofacitinib.
Clinicians face clinical challenges with respect to choosing appropriate treatment regimens for individual patients. Some patients fail to respond to initial treatment with a selected agent (primary treatment failure). Other patients improve initially with a treatment regimen but experience a loss of response over time. Options for patients with inadequate response to TNF inhibitors include the use of alternate TNF inhibitors, non-TNF biologics, or tofacitinib. Some of these agents may be used as monotherapy, reducing risk for side effects of methotrexate. However, clinicians should be aware of and carefully evaluate the monotherapy studies involving these agents. This educational program provides evidence-based information in an accessible format for clinicians, with the overall goals of increasing clinician’s confidence and skill in adopting newer treatment approaches including options following TNF failure and monotherapy with biologics that have mechanisms of action other than TNF inhibition.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Rutgers, The State University of New Jersey, and Global Academy for Medical Education, LLC. Rutgers, The State University of New Jersey, is accredited by the ACCME to provide continuing medical education for physicians.
Rutgers, The State University of New Jersey, designates this enduring material for a maximum of 2.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity
Rutgers, The State University, Center for Continuing and Outreach Education is an approved provider of continuing nursing education by the New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission On Accreditation. Provider Number P173-12/12-15.
This activity is awarded 2.33 contact hours (60 minute CH).
Nurses should only claim those contact hours actually spent participating in the activity.
Disclosure Declarations
In accordance with the disclosure policy of Rutgers and to conform with ACCME and FDA guidelines, individuals in a position to control the content of this educational activity are required to disclose: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of nonprofit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.

Faculty Disclosures
Jeffrey Curtis, MD
Dr. Curtis has received grant research support from: AbbVie Inc, Amgen, Inc, Bristol-Myers Squibb, Crescendo Bioscience, Inc, CORRONA, Ortho-McNeil-Janssen Pharmaceutical Company, Roche/Genentech, Pfizer Inc., and UCB. He has also been a consultant for: AbbVie, Amgen, Bristol- Myers Squibb, Crescendo Bioscience, Inc, CORRONA, Ortho-McNeil-Janssen Pharmaceutical Company, Pfizer Inc., and UCB.
Jonathan Kay, MD
Dr. Kay has received grant research support from: AbbVie Inc, Eli Lilly and Company, Hoffmann-LaRoche Ltd, and Pfizer Inc. He has also been a consultant for: AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim GmbH, Bristol- Myers Squibb, Crescendo Bioscience, Inc, Eli Lilly and Company, Epirus Biopharmaceuticals, Inc, Genentech, Hospira, Inc, Janssen Biotech, Merck Sharp & Dohme Corp, Nippon Kayaku Co, Ltd, Novartis Pharmaceuticals Corporation, Pfizer Inc., Samsung Bioepis, and UCB, Inc.
Gregg Silverman, MD
Dr. Silverman has received grant research support from: National Institutes of Health, American College of Rheumatology, Rheumatology Research Foundation. He has also been a consultant for: Pfizer Inc., Eli Lilly and Company, and Hoffmann-LaRoche Ltd.

Peer Review Statement
In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, CCOE has resolved all potential and real conflicts of interest through content review by a nonconflicted, qualified reviewer. This activity was peer-reviewed for relevance, accuracy of content, and balance of presentation by:  Ashraf Raslan, MD, Rheumatology Fellow (PGY-5), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ and Claudia Carron, MSN, RN, Staff Nurse, Educator, Point of Care Coordinator, Pathology, Rutgers Robert Wood Johnson Medical, New Brunswick, NJ. Dr. Raslan and Ms. Carron have no relevant financial relationships to disclose.
Field Testers: This activity was pilot-tested for time required for participation by: Physicians:  Daniel Grabell, MD, Reena Khianey, MD, Clifford Stermer, MD. Nurses: Geraldine Bocchieri, RN, BSN, Kathleen Brown, LPN, Carol Ruland, RN. The field testers have no relevant financial relationships to disclose.
CCOE Staff: Tristan Nelsen, MNM, CMP, and Elizabeth Ward, MJS, have no relevant financial relationships to disclose.
Global Academy for Medical Education Staff: Sylvia H. Reitman, MBA, DipEd; Mike LoPresti, Shirley V. Jones, MBA; and Joshua Kilbridge have no relevant financial relationships to disclose.
Off-label/Investigational Use Disclosure
This activity does not contain information of commercial products/devices that are unlabeled for use or investigational uses of products not yet approved.  
This continuing education activity was developed from a roundtable with the faculty held August 1, 2015, in New York, NY. The faculty acknowledge the editorial assistance of Global Academy for Medical Education and Josh Kilbridge, medical writer, in the development of this program. Neither the editors of Rheumatology News nor the Editorial Advisory Board nor the reporting staff contributed to its content. The opinions expressed are those of the faculty and do not necessarily reflect the views of the supporters, Global Academy for Medical Education, Rutgers, or of the Publisher.
Copyright © 2015 by Global Academy for Medical Education, LLC, and its Licensors. All rights reserved. No part of this activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the Publisher. Global Academy for Medical Education, LLC will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this activity, including any claims related to the products, drugs, or services mentioned herein. Developed in the United States of America.

Provider Contact Information
Please direct content- or CE-related questions or concerns to CCOE at 973-972-4267 or email ccoe@ca.rutgers.edu.
Contact Information for Technical Questions
Please direct technical questions or concerns to Global Academy for Medical Education at 973-290-8225 or email info@globalacademycme.com.
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