Rheumatologists are accustomed to educating patients about medications—but biologic medications require some additional time and discussion. “Biologics are inherently more complex [than other medications], and there are multiple issues to consider before initiating treatment,” says K. “Kwas” Huston, MD, The Center for Rheumatic Disease, Kansas City, Mo. “This includes the patient’s disease activity, prior medications used, comorbidities, potential adverse effects, cost, patient preference and route of administration.”
Because biologics pose more factors to consider, it’s even more crucial that health providers devote an adequate amount of time to patient education.
How It Works
Although every office is different, what often happens is that the rheumatologist broaches the subject of biologics. For example, in Dr. Huston’s office, the physician provides a basic understanding of biologics and their side effects and reviews information about cost and insurance coverage. This is also the time Dr. Huston talks about necessary vaccinations and screening tests (e.g., for hepatitis and latent tuberculosis). Then, a nurse or medical assistant teaches about subcutaneous injections and goes over when patients should hold their medication—such as when they have an infection, are undergoing a significant surgery or are contemplating pregnancy.
At his practice, Orrin M. Troum, MD, Providence Saint John’s Health Center, Santa Monica, Calif., finds that most patients come to the office with some concept of what biologics are. However, he always leaves in some extra time to discuss the medication.
Most offices use supplementary information, such as brochures or written materials, for patients to review. These kinds of resources come from nonprofit organizations and pharmaceutical manufacturers. Ellen Field, MD, Lehigh Valley Health Network, Bethlehem, Pa., leads patients to Joint Decisions, an online resource to help people who have rheumatoid arthritis (www.jointdecisions.com; Janssen Biotech).
“Before the patient leaves, I find it imperative to ask him or her to come back with a list of questions at the next time of their visit. They need some time to explore the educational sites and information available about treatment options, including biologics, to formulate their questions and concerns,” Dr. Field says.
The risk–benefit balance is an important component to broach when talking with patients about biologics, says Anca Askanase, MD, clinical director and founder of the Lupus Center at Columbia University Medical Center, New York. “There is a lot of angst over the side effects, and I believe it is the doctor’s job to alleviate the patients’ or families’ concerns.”
And Your Questions Are …?
Some common questions that rheumatologists encounter during discussion of biologics include:
- What are the risks vs. benefits of biologic therapy?
- How much will it cost?
- Will my insurance cover it?
- What is the risk for cancer if I use a biologic?
- What are the side effects?
- Can I do the injection myself?
- What does remission for my disease look and feel like? Will I ever be able to discontinue treatment?
- How can treatment with biologics fit in with alternative medicine approaches? Can I first try non-biological treatments and see how they work?
- Why might the treatment sometimes stop working? What would happen next?
The cost issue is especially concerning to patients, Dr. Huston says. “We all see patients who would benefit from biologic therapy, but cannot access these drugs due to high cost and inadequate insurance coverage. Ensuring access to treatment is one of the more important challenges we face,” he says.