Targeting the IL-6 Receptor in RA--Clinical Potential of non-TNF Inflammatory Pathways

Faculty

Needs Statement

Rheumatoid arthritis (RA) afflicts 2.1 million Americans (www.niams.nih.gov). A progressive disease of the joints with a recognized autoimmune component, RA causes eventual loss of joint structure and function. The disease is also associated with serious extraarticular and comorbid disease, best revealed by studies identifying a 10-15 year shorter lifespan for patients with RA.

RA adversely affects the cardiovascular system, renal and pulmonary function, and the mucosa of the mouth and eyes. RA also serves as a model for the anemia of chronic disease. The results of one study, conducted in over 3,000 RA patients followed for up to 35 years, revealed a greater than 2-fold mortality ratio for RA patients, with most deaths attributed to cardiac and cerebrovascular events.

The systemic manifestations of RA are linked to the inflammatory cytokine network. With the introduction of a number of highly effective TNF blockers into clinical practice, TNF has received significant attention as a principal mediator of joint damage in RA. However, approximately 50% of RA patients fail to mount a significant response to these important therapeutic agents. This finding suggests that other inflammatory cytokines play a predominant role in the articular and systemic pathophysiology of RA.

Recent investigation has revealed a prominent role for IL-6, and for soluble and cell-bound IL-6 receptors in the RA immune network. The proposed CME activity will address the function of these mediators in the articular and systemic manifestations of RA. The safety and efficacy of the first IL-6 receptor antagonist, tocilizumab, will be reviewed to underscore the importance of targeting this pathway in patients with RA.

Target Audience

This activity is designed to educate rheumatologists, nurses, and other healthcare professionals administering biological therapy for the treatment of rheumatoid arthritis.

Objectives

1. Correctly position IL-6 and TNF in the inflammatory cascade that mediates the pathophysiology of rheumatoid arthritis;
2. Summarize current knowledge of the clinical efficacy and safety of tocilizumab and the TNF blockers;
3. Describe the potential clinical advantages and challenges associated with the use of tocilizumab and TNF blockers.

Accreditation

Medicine
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and CTI Clinical Trial & Consulting Services. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Pharmacy
The University of Kentucky College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This activity has been assigned ACPE # 022-999-08-090-H01-P and will award up to 1.00 contact hours (0.1 CEUs) of continuing pharmacy education credit in states that recognize ACPE providers.

Statements of credit will indicate hours and CEUs based on participation and will be issued online at the conclusion of the activity. Successful completion includes completing the activity, its accompanying evaluation and/or posttest (score 70% or higher) and requesting credit online at conclusion of the activity. The College complies with the Accreditation Standards for Continuing Pharmacy Education.

Nursing
Educational Review Systems is an approved provider of continuing education in nursing by ASNA, an accredited provider by the ANCC/Commission on Accreditation and designates this educational activity for a maximum of 1.00 hour(s). Provider # 5-115-08-089

Educational Review Systems is also approved for nursing continuing education by the state of California and the District of Columbia.

Faculty Disclosure

Dr. Fleischmann has received consultation fees and has contract research support for Abbott, Amgen, Centocor, Genentech, Roche and Wyeth and has been on Amgen and Wyeth Speakers Bureaus.

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and CTI Clinical Trial & Consulting Services. Supported by an unrestricted educational grant from Roche Pharmaceuticals.