“Neither trial addresses the subject of immunogenicity in patients who switch from the reference medicine, which could occur in the case of interchangeable without the prescribing physician’s knowledge,” Dr. Goodman notes. In addition, the safeguards and requirements for physician and patient notice for interchangeables differ from state to state.
Be Wary of Increased Heart Attack Risk with NSAIDs
In July 2015, the FDA increased its warning about the effects of NSAIDs on the cardiovascular system. Rheumatologists should be aware of this. They are more likely to have a heart attack following the first few weeks of therapy. The risk is also enhanced with greater NSAID doses and in people who do not have an underlying cardiac disease—though the risk is most significant in people who do have underlying cardiac disease. The FDA advises patients and practitioners to be on the lookout for heart-related side effects.
‘When RA medicines are approved in the United States, the approval of biosimilars will add complication to rheumatology practice.’ — Susan M. Goodman, Ph.D.
“Risk-benefit conversations for patients with previous cardiac illness and smokers should reflect the increased awareness of the cardiovascular risk of NSAIDs,” Dr. Goodman says. “For many patients, the benefits of continued function and quality of life outweigh the risks, and judgments can be taken on an individual basis when acetaminophen alone does not provide adequate alleviation of symptoms.”
Conclusion
When treating a newly diagnosed RA patient, consult the organization’s standard practices first. Then, assess each patient, outlining their unique needs and aspirations. Follow-up evaluations are required to establish the best course of treatment.