Dr. Farrell also discussed newer targeted synthetic DMARDs, such as apremilast, an inhibitor of phosphodiesterase 4 used for the treatment of certain types of psoriasis and psoriatic arthritis, and tofacitinib, a JAK inhibitor. Apremilast may also be useful for other immune system-related inflammatory diseases. “But we have had a hard time getting these newer drugs approved by insurance companies. Again, clear communication with patients is needed, especially if there could be a delay in access to medication.”
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It is important to titrate the dose of the medication in response to side effects, which are more intense in early stages. These include diarrhea, nausea, weight loss, headaches and risk for infection.
“I can’t not mention biosimilars,” Dr. Farrell said. “These are going to make things very interesting from an administrative perspective, generating lots of confusion. Patients need to be educated that these are coming and that their medications might get switched. For our patients, we will create FAQs regarding biosimilars.”
Larry Beresford is a freelance medical journalist in Oakland, Calif.