Supplement
Issue:
Improving Clinical and Managed Care Outcomes in Rheumatoid arthritis: a Focus on Comparative Effectiveness of Current Treatments [CME/CPE]
Volume:
18
Number:
13 Suppl
Release date: November 12, 2012 |  Expiration date: November 12, 2013
Estimated time to complete activity: 3 hours
Type of Activity: Knowledge  |  Medium: Print with Internet-based posttest, evaluation, and request for credit

This activity is supported by an educational grant from Bristol-Myers Squibb.

Intended Audience
Medical directors, pharmacy directors, specialty pharmacists, and other managed care professionals who oversee the care of patients with rheumatoid
arthritis.

Statement of Educational Need
Rhuematoid arthritis (RA) is the most common form of inflammatory arthritis, with a prevalence rate of approximately 1% and an annual incidence of 3 per 10,000 adults. Polyarticular synovial inflammation leading to joint swelling, stiffness, and tenderness is the major cause of initial disability. Over time, synovial inflammation leads to cartilage damage, bone erosions, and joint destruction—the major causes of long-term disability. In addition, patients with RA have increased mortality compared with the general population, largely attributed to an increased risk of cardiovascular disease. The burden of illness associated with RA not only impacts patients and families, but also society through sick leave, loss of work productivity, and utilization of healthcare resources.

Fortunately, management of this daunting disease has been largely transformed from mere symptom control with analgesics and corticosteroids to disease control with disease-modifying antirheumatic drugs (DMARDs) and biologic agents. Over the last decade, optimal use of traditional DMARDs (in particular the anchor methotrexate), as well as availability of biologic agents (eg, tumor necrosis factor [TNF] antagonists, interleukins, T-cell and B-cell agents) have dramatically enhanced the success of RA management by slowing disease progression, improving clinical outcomes, and reducing the accrual of joint damage and disability. With a greater emphasis placed on comparative effectiveness of these therapies, it is imperative that clinicians be aware of emerging research. These critical data are likely to impact clinical decisions on treatment strategies, especially as they relate to appropriate timing and initiation of various DMARDs and the management of patients with more complex RA, such as those with moderate-to-severe disease who are nonresponsive to TNF antagonists.

Educational Objectives
Upon completion of the educational activity, the participant should be able to:
  • Describe the epidemiology, burden, and pathophysiology of RA
  • Discuss current management of RA, examining comparative effectiveness of DMARDs and biologic agents
  • Examine managed care aspects of RA, including direct and indirect medical costs and the role of specialty pharmacy
  • Discuss the role of disease therapy management programs in optimizing patient outcomes, including adherence and persistence with treatment

Activity Fee
Physician: This activity is free of charge for physician participants requesting AMA PRA Category 1 CreditTM.
Pharmacist: The activity is free for participants submitting evaluation forms and posttests online for pharmacy credit. For participants submitting their posttests/evaluation forms and requests for credit via fax or mail, there is a nominal fee of $10.00.

Disclosure Policy
According to the disclosure policies of Physicians’ Education Resource, LLC, and Pharmacy Times Office of Continuing Professional Education, all persons who are in a position to control content are required to disclose any relevant financial relationships with commercial interests. If a conflict is identified, it is the responsibility of Physicians’ Education Resource and Pharmacy Times Office of Continuing Professional Education to initiate a mechanism to resolve the conflict(s). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

Physician Credit
Accreditation Statement / Credit Designation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Physicians’ Education Resource and Pharmacy Times Office of Continuing Professional Education. Physicians’ Education Resource is accredited by the ACCME to provide continuing medical education for physicians.

Physicians’ Education Resource designates this journal-based CME activity for a maximum of 3.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Credit
Accreditation and Credit Designation
Pharmacy Times Office of Continuing ProfessionalEducation is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing
pharmacy education. This activity is approved for 3.0 contact hours (0.30 CEUs) under the ACPE universal activity number 0290-9999-12-093-H01-P.The activity is available for CE credit through November 12, 2013.

Obtaining Credit
Participants must read each article in this supplement, complete the posttest (achieving a passing score of 70% or higher), and complete an evaluation and request for credit. Detailed instructions on obtaining CE credit are included on the evaluation/posttest page contained in this supplement.

Faculty
William J. Cardarelli, PharmD
Director of Pharmacy Revenue and Supply
Atrius Health
Harvard Vanguard Medical Associates
Watertown, Massachusetts

Allan Gibofsky, MD, JD, FACP, FCLM
Professor of Medicine and Public Health
Weill Medical College of Cornell University
Attending Rheumatologist
Hospital for Special Surgery
New York, New York

Editorial Support
Andrew Scott Mathis, PharmD
Pharmacy Department
Monmouth Medical Center
Long Branch, New Jersey

Faculty Disclosures
These faculty have disclosed the following relevant commercial financial relationships or affiliations in the past 12 months.

William J. Cardarelli, PharmD, has no relevant financial relationships with commercial interests to disclose.

Allan Gibofsky, MD, JD, FACP, FCLM
Consultant/advisory board, honoraria, lectureship, stock ownership: Abbott, Amgen, Genentech, Pfizer, and UCB
Stock ownership: Johnson & Johnson; GlaxoSmithKline

Andrew Scott Mathis, PharmD, has no relevant financial relationships with commercial interests to disclose.

The American Journal of Managed Care
Publishing Staff—Jeff D. Prescott, PharmD, RPh; Kara Guarini, MS; and Ida Delmendo have no relevant financial relationships with commercial interests to disclose.

Pharmacy Times Office of Continuing Professional Education and Physicians’ Education Resource, LLC
Planning Staff—Judy V. Lum, MPA; and Elena Beyzarov, PharmD, have no relevant financial relationships with commercial interests to disclose.

Signed disclosures are on file at the office of The American Journal of Managed Care, Plainsboro, New Jersey.

Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, the editorial staff, or any member of the editorial advisory board. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, is not responsible for accuracy of dosages given in articles printed herein. The appearance of advertisements in this publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

System Requirements
PC-based participants
Windows 7, Vista, XP, 2003 Server, or 2000

Macintosh®-based participants
Required: Mac OS X 10.4.11 (Tiger) or newer

© 2012 Managed Care & Healthcare Communications, LLC
ARTICLES
Allan Gibofsky, MD, JD, FACP, FCLM
Allan Gibofsky, MD, JD, FACP, FCLM
William J. Cardarelli, PharmD
AUTHOR INDEX
CE/CME QUIZ