If efficacy is found with kinase inhibitors but the cost of these agents is less than current biologics, Dr. Fleischmann said, methotrexate still will likely be the first DMARD used, followed by a kinase inhibitor and then a TNF inhibitor.
If new studies do not find that kinase inhibitors are as favorable as TNF-1 or other biologics and their cost is higher than what’s currently available, Dr. Fleischmann believes a treatment scenario of methotrexate followed by TNF-1s would be likely. “These agents would be the last ones used,” he said.
That said, Dr. Fleishmann predicted that the efficacy and safety of the kinase inhibitors will remain static with what research has found so far.
“I think, regardless of cost, most rheumatologists initially will use these medications in patients unresponsive to biologics,” Dr. Fleischmann said. “If they are successful, they will expand their use over time. Cost, patient preference, and comorbidities may lead to early adoption or avoidance.”
Vanessa Caceres is a freelance medical writer in Bradenton, Florida.
