Armada Summit CE Session: The Role of Specialty Pharmacy in Improving Outcomes for Rheumatoid Arthritis Patients

Pharmacists can assist patients with rheumatoid arthritis in overcoming challenges to adherence.

Specialty pharmacies play a vital role in managing rheumatoid arthritis (RA) treatment due to the high incidence of adverse events from medications, according to Gary Rice, RPh, MS, MBA, CSP, vice president of clinical services at Diplomat Specialty Pharmacy.

Rice presented a continuing education session on improving outcomes for RA patients on May 8, 2014, at the annual Armada Health Care Specialty Pharmacy Summit and Expo in Las Vegas. The program was sponsored by the Pharmacy Times Office of Continuing Professional Education and the Specialty Pharmacy Association of America, and was supported by an educational grant from Bristol-Myers Squibb.

Due to the debilitating symptoms brought on by both the disease and treatment, Rice said it’s vital for specialty pharmacists to closely monitor the physical well-being of RA patients.

“It’s really important for pharmacists to monitor fatigue,” he said. “Clinical studies have demonstrated that physicians don’t use fatigue as a quantitative measure of the effectiveness of RA treatments. Often, it’s fatigue that is having a larger impact on patients from a standpoint of absenteeism in their daily activities.”

During the session, Rice discussed common symptoms and treatment options, in addition to various side effects and other hurdles related to treatment for RA. From a health plan perspective, RA is one of the more costly diseases to treat, he noted, and incidents of the disease continue to rise despite the availability of high-quality aggressive treatments. Although commonly thought of as a disease that impacts smaller and larger joints, RA also affects major organs, such as the heart.

“These patients tend to die at a younger age than the general population,” Rice told the audience. “Keep in mind, this is an autoimmune disease and most of these patients die from cardiovascular complications from the disease.”

Approximately 1.3 million adults in the United States have been diagnosed with RA, which typically impacts individuals between the ages of 20 and 40 years, although any age group is susceptible. Family history also increases the risk for RA.

RA affects the smaller joints (wrists, hands, ankles, feet) at the onset of the disease as patients alternate between periods of increased inflammation and periods of remission. After 10 years, 50% of young working patients with RA are disabled.

“Patients may lose their grip strength and they may lose the ability to do daily activities with their knees and feet,” Rice said. “Often for patients, it’s the feet and hands that are really creating the chief complaints for visiting a physician.”

In the treatment of RA, patients are typically prescribed nonsteroidal anti-inflammatory drugs, corticosteroids, non-biologic disease modifying anti-rheumatic drugs (DMARDs), or biologic DMARDs. Biologic DMARDs are effective in patients who don’t see progress with traditional agents, but the drugs also carry a greater risk of bacterial infection.

Rice noted that the adverse side effects associated with DMARDs are a reason for patient nonadherence. Due to these issues, Rice said pharmacists must be proactive in advising patients on how to manage DMARD therapy.

“It’s a great opportunity for the pharmacist to counsel these patients on what to be watchful of and how to minimize some of the side effects,” he said.

A change in normal day-to-day physical activity can also mask the efficacy of certain treatments. Rice cited the example of a patient who had recently moved to a new home before she came in for a regular assessment. As a result of the strenuous activity, the patient, who was not otherwise physically active, had a lower than normal score in her joint evaluations.

This result was not an indication of the efficacy of her medication, but of the impact a drastic change in physical activity can have on RA patients, Rice said.

Due to these fluctuations, Rice said pharmacists need to ask follow-up questions when they survey patients to determine the cause of physical issues and nonadherence.

“[Asking questions] is really important in this disease where there are cycles of remission and flares, where daily activities have an impact on some of the assessments, and where there are medically justifiable reasons for not being on therapy due to infections, the flu, or other reasons,” Rice said. “It’s really important that you understand what is going on with that patient.”

Click here for more information on CE sessions offered by the Pharmacy Times Office of Continuing Professional Education for specialty pharmacy.