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    Home > Active Ingredient News > Immunology News > Treasurer Cookie's single-resistance success "quite" into health insurance, treatment AS has great success

    Treasurer Cookie's single-resistance success "quite" into health insurance, treatment AS has great success

    • Last Update: 2021-03-23
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference.
    After the medical insurance policy is implemented, the availability of prices has given more patients new choices.

    At the end of December 2020, the results of the latest medical insurance negotiations were announced.

    In the newly announced National Medical Insurance Catalogue, Skukuzumab is included as the first and currently the only interleukin-17A (IL-17A) inhibitor for the treatment of ankylosing spondylitis (AS) in China.

    The updated medical insurance catalogue has been officially launched and implemented nationwide from March 1 this year.

    We take this opportunity to invite Professor Duan Xinwang from the Second Affiliated Hospital of Nanchang University and Professor Wei Wei from the General Hospital of Tianjin Medical University to share their views.

    Interview video of Professor Duan Xinwang and Professor Wei Wei 1 AS patients ushered in a new spring in the era of biological preparations Professor Duan Xinwang believes that the current delay rate in the diagnosis of AS in my country is high, and the time of diagnosis can be delayed by 5-8 years or even longer, which seriously affects the patient’s condition .

    Before the emergence of various biological agents, many patients did not go to regular departments for treatment and the diagnosis and treatment process was not standardized.

    There are only non-steroidal anti-inflammatory drugs (NSAIDs) and traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs).
    However, traditional drug treatments are increasingly unable to meet the needs of patients.
    Even with early treatment, many patients still have a poor prognosis.

    It has a very big impact on the patient's family life, social work and psychological aspects.

    As more and more biologics are on the market and gradually enter medical insurance, including tumor necrosis factor inhibitors (TNFi), IL-17A inhibitors, etc.
    , the current treatment of AS has entered the era of biologics, and the availability of prices will affect patients with AS.
    There is one more treatment option, allowing more patients to benefit from clinical remission, disease control and imaging prognosis.

    2 Early use of biologics can benefit patients with AS in many ways.
    1 The sooner the biologics are activated, the better.
    Professor Wei Wei said: "The earlier the biologics are activated, the better. Once the patient has formed osteophytes or even bone bridge connections, the significance of using biological agents is certainly not as beneficial as early application.

    "Theoretically, biologics treatment should be initiated once AS is diagnosed.

    However, considering foreign guidelines and the economic situation of Chinese patients, the current first-line treatment for AS is still NSAIDs.
    Biologics should be initiated when the following conditions occur.
    Preparations (TNFi or IL-17A inhibitors) for treatment: (1) Patients with poor efficacy under conventional treatment: ≥2 NSAIDs treated for more than 4 weeks (total), symptoms are not relieved and/or toxic reactions occur; (2) Patients with severe symptoms, such as higher disease activity, elevated C-reactive protein (CRP) levels, and/or positive MRI/radiology of sacroiliac arthritis, hope to eliminate symptoms as soon as possible [1].

    Professor Wei Wei believes that the more patients are Early use of biological agents will increase the chances of discontinuation in the future.
    Therefore, in the future, we will further study which patients can achieve remission after using biological agents as soon as possible.
    It may help reduce the withdrawal of drugs and avoid the side effects of long-term application.
    The country is saving medical resources.

    2 To improve the quality of life of patients, biological preparations are indispensable.
    Early use of biological preparations can effectively relieve low back pain and reduce disease activity [2], which helps to slow down the progress of imaging, such as osteophytes Formation, bone erosion or bone destruction [3].
    This
    greatly improves the quality of life of patients.

    33 categories of people require early intervention and treatment (1) MRI examination of the lesion is positive, such as patients with bone marrow edema, fatty deposits, ligament osteophytes ; (2) Patients with high baseline inflammatory levels (CRP, ESR); (3) Smoking, obesity, high disease activity, etc.
    are risk factors for the imaging progression of axial spondyloarthritis (axSpA).
    These patients may It is necessary to use biological interventions as soon as possible [4].

    3IL-17A inhibitors delay the progress of structural damage and help AS achieve standard treatment.
    Professor Duan Xinwang emphasized that the main goal of AS treatment is to control symptoms and inflammation, prevent the progressive destruction of structures, and maintain/normalize Chemical function and social participation, to maximize the quality of life related to patients’ health [1,5].
    The
    earliest treatment of AS is TNFi, but not all patients are suitable for TNFi.

    With the entry of Skucilizumab into medical insurance, the price has been significantly reduced, and more and more patients will choose biological treatment, and more patients will benefit.

    Skukuzumab can specifically block IL-17A, regulate the pathological process of AS at multiple levels, and inhibit inflammation.
    Within 5 years, nearly 80% of patients have sustained relief of symptoms and signs [6], inhibiting the formation of new bone and delaying structural Progression of the injury helps to achieve the treatment of AS.

    4IL-17A inhibitors are safer than TNFi.
    China is a big country with tuberculosis and hepatitis B.
    AS patients have a high rate of tuberculosis and HBV infection.
    One out of every four AS patients may be tuberculosis or HBV infection [7-8].

    Many patients are infected during the incubation period or have been infected with tuberculosis in the past.
    Once a biological agent is used, tuberculosis may recur.

    At present, due to the widespread inoculation of hepatitis B vaccine in my country, the infection rate has been significantly reduced, but it is still much higher than that of the western population.

    Although the hepatitis B virus is in the quiescent phase, the use of biological agents can make the virus active again, and it is explosive, which can lead to liver failure or hepatic coma, and even endanger the life of the patient.

    Therefore, Professor Wei Wei emphasized that hepatitis B and tuberculosis must be screened before applying biological agents.

    Many studies have shown that TNFi can increase the incidence of tuberculosis and hepatitis B, while IL-17A inhibitors will not increase the risk of tuberculosis and hepatitis B [9].

    Professor Duan Xinwang considers the following factors: 1 Against tuberculosis (1) TNF-α can increase the phagocytic capacity of macrophages and kill Mycobacterium tuberculosis, which can promote the formation of surrounding granulomas after Mycobacterium tuberculosis infection, and block Its dissemination.

    The application of TNFi therapy may increase the risk of tuberculosis [10-11].

    (2) In the current study, there has been no report of increased susceptibility to tuberculosis in the treatment of AS.

    2 Regarding hepatitis B (1) The 2006 national hepatitis B seroepidemiological survey showed that the HBsAg carrier rate of the general population aged 1-59 years in my country is 7.
    18% [12].
    In the treatment of AS patients: TNFi is used for non-preventable non-prevention For active HBV carriers, the incidence of HBV reactivation is 16.
    6%. (2) According to the literature published between 2015 and February 2020, there are no reports of reactivation of hepatitis B in patients with AS using tecyuumab.

    On the whole, IL-17A inhibitors are better than TNFi in terms of safety, but patients still need to be closely tested for tuberculosis and hepatitis B to prevent infection during treatment.

    5 After the implementation of medical insurance, you can better manage patients in multiple dimensions.
    Professor Wei Wei said that if you blindly follow textbooks or guidelines to see a doctor, you don't need a doctor.

    Therefore, individualized treatment is a principle that doctors must follow.
    It is necessary to consider the efficacy and side effects to provide individualized treatment for patients.

    1 Focusing on the patient, optimizing individualized clinicians need to understand the treatment needs from the perspective of the patient, and pay attention to the patient's major disease burden and unmet treatment needs.

    Patients are most afraid of disease progression, pain, and loss of mobility, and hope that drug treatment can stop disease progression, eliminate pain, and improve mobility and quality of life in the future.

    2 After the transformation of treatment concepts and the upgrading of treatment methods, the medical insurance is no longer a problem.
    The price and accessibility of medicines are no longer a problem.
    AS treatment should not only be symptom control, but also need to pay attention to the multi-dimensional compliance of AS, and upgrade from simple treatment to AS.
    In disease management, multidisciplinary cooperation should be conducted in disease management of AS patients, taking into full consideration the patient’s comorbidity, mental health, education level, social support and economic status, etc.
    , to regularly evaluate the self-management behavior of AS patients and implement personalized biology- Psychological-social factor management.

    3 Doctors and patients make joint decisions and communicate with patients and their families in a timely manner, so that patients and their families can understand the disease, cooperate with long-term use of biological agents, avoid psychological burdens, and establish a determination to standardize diagnosis and treatment.

    And after the condition has gradually stabilized, the drug must not be discontinued or reduced without authorization, causing the condition to repeat itself.
    It is necessary to perform clinical follow-up and doctor's evaluation to further determine whether the drug can be reduced or stopped.

    6 Summary After the implementation of the medical insurance policy on March 1, the availability of prices has allowed more patients to have new choices, and Skucilizumab has great advantages in alleviating symptoms, reducing disease activity and inhibiting the progress of imaging.
    Advantages, hope to benefit more AS patients in the future. Expert profile Professor Duan Xinwang, Director of the Department of Rheumatology and Immunology, the Second Affiliated Hospital of Nanchang University, Chief Physician, Master's Tutor, National Committee of the Chinese Medical Association Rheumatology Branch, Standing Committee Member of the Rheumatology and Immunology Physician Branch of the Chinese Medical Doctor Association Rheumatology and Immunology Branch of the Chinese Medical Doctor Association Member of the Disease-related Pulmonary Vascular/Interstitial Diseases Group Member of the Vasculitis Group of the Rheumatology and Immunology Physician Branch of the Chinese Medical Doctor Association Standing Director of the Chinese Association of Rheumatology and Immunology Medical Association Standing Committee Member of the Immune Purification and Cell Therapy Group of the Chinese Medical Association Cross-Strait Standing member of the Rheumatology Expert Committee of the Medical and Health Exchange Association Member of the Vasculitis Group of the Rheumatism Expert Committee of the Cross-Strait Medical and Health Exchange Association Member of the Osteoarthritis Group of the Rheumatism Expert Committee of the Cross-Strait Medical and Health Exchange Association Member of the Chinese Systemic Lupus Erythematosus Research Collaboration Group Head of the unit National Rheumatology Data Center Member of the Cooperative Unit Head of the Rheumatology Expert Committee of the Beijing Medical Awards Foundation Member of the Bethune Public Welfare Foundation Rheumatology Professional Committee Member of the Chinese Medical Doctors Association Immunoabsorption Professional Committee Member of the Chinese Society of Rehabilitation Medicine Bone, Joint and Rheumatism Member of the Professional Committee of Diseases, Chairman of the Rheumatology Branch of Jiangxi Research Hospital Association, Deputy Chairman of the Rheumatology Branch of Jiangxi Medical Association Professor Wei Wei, Director of the Department of Rheumatology and Immunology, General Hospital of Tianjin Medical University, Chief Physician, Doctoral Supervisor Chinese Medicine Standing member of the Rheumatology Branch of the Chinese Medical Doctor Association Standing member of the Rheumatology Branch of the Chinese Medical Doctor Association Rheumatology-related Pulmonary Vascular/Interstitial Disease (Science Group) Committee Vice Chairman of the Rheumatology Branch of the Chinese Medical Doctor Association Chairman of the Rheumatology Branch of the Tianjin Medical Association Vice President of the Rheumatology Branch of Tianjin Medical Doctors Association Standing Committee Member of the Rheumatology Professional Committee of the Cross-Strait Medical and Health Exchange Association Member of the Vasculitis Group of the Rheumatism Immunology Professional Committee of the Cross-Strait Medical and Health Exchange Association Member of the Bone, Joint and Rheumatology Department of the Chinese Association of Rehabilitation Medicine Committee members reviewed the journey of "treasure" discovery: IL-17A's "Three Heads and Six Arms", how can IL-17A exert its diversified biological functions? Explore the key role of IL-17A in ankylosing spondylitis.
    Why can it be a key target for treatment? Looking back at the story of monoclonal antibodies, and seeing how to continue to write the legend, how to know horsepower, and to explore the truth about the secondary failure of biological preparations, do biological preparations need to use loading doses? The clinical evidence has the final say! Taking the "unusual" road, IL-17A inhibitors have overcome obstacles and pursue excellence all the way! The path of change in the treatment of ankylosing spondylitis: from "symptomatic treatment" to "full management", the new medical insurance catalogue is officially implemented.
    What changes will it bring to the diagnosis and treatment of AS? How does the "three-headed six-arm" IL-17A exert its diverse biological functions? Explore the key role of IL-17A in ankylosing spondylitis.
    Why can it be a key target for treatment? Looking back at the story of monoclonal antibodies, and seeing how to continue to write the legend, how to know horsepower, and to explore the truth about the secondary failure of biological preparations, do biological preparations need to use loading doses? The clinical evidence has the final say! Taking the "unusual" road, IL-17A inhibitors have overcome obstacles and pursue excellence all the way! The path of change in the treatment of ankylosing spondylitis: from "symptomatic treatment" to "full management", the new medical insurance catalogue is officially implemented.
    What changes will it bring to the diagnosis and treatment of AS? How does the "three-headed six-arm" IL-17A exert its diverse biological functions? Explore the key role of IL-17A in ankylosing spondylitis.
    Why can it be a key target for treatment? Looking back at the story of monoclonal antibodies, and seeing how to continue to write the legend, how to know horsepower, and to explore the truth about the secondary failure of biological preparations, do biological preparations need to use loading doses? The clinical evidence has the final say! Taking the "unusual" road, IL-17A inhibitors have overcome obstacles and pursue excellence all the way! The path of changes in the treatment of ankylosing spondylitis: From "symptomatic treatment" to "full management", the new medical insurance catalog is officially implemented.
    What changes will it bring to the diagnosis and treatment of AS?
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