Peter Nash, MD
Professor of Department of Medicine
Director of Rheumatology Unit on the Sunshine Coast
University of Queensland
Queensland, Australia
What are accepted treatment triggers for employing disease-modifying anti-rheumatic drugs (DMARDs)? And what classes of biologic agents — including IL-6 inhibitors and others — have demonstrated efficacy as monotherapy?
What is the precise immunopathobiologic mechanism of action for agents targeting IL-6 in the setting of RA? Are these MoAs synergistic with other MoAs? If so with which other agents should IL-6 targeting agents be used?
What are the strategies for individualizing treatment in patients with RA?
What are the strategies for individualizing treatment in patients with RA?
How long of a trial using traditional DMARD therapy with methotrexate do you recommend prior to intensifying treatment with a biologic agent?
Among the biologic agents, are there any significant efficacy or safety differentiators that prompt you to deploy one agent in preference to another, in any particular sequence?
When a suboptimal clinical response has been encountered with TNF, do you recommend switching to a biologic with a different MoA, such as an IL-6 inhibitor or co-modulating agent?
When a suboptimal clinical response has been encountered with a traditional DMARD, what therapeutic approaches for escalating therapy are appropriate?
What is your assessment of the cardiovascular risk profile associated with IL-6 therapy? And the possible role of IL-6 inhibition as a mitigator of any effects related to LDL elevation?
What metabolic or hematologic markers should we monitor in patients on IL-6 therapy?
What metabolic or hematologic markers should we monitor in patients on IL-6 therapy?What are the risks for infection when treating RA patients with biologics?
What are the risks for infection when treating RA patients with biologics?