What changes will the introduction of IL-17A inhibitors into medical insurance bring to the AS "ecological circle"?

*Only for medical professionals to read for reference.
Skuchiyuumab enters medical insurance to promote the process of AS disease management.

On March 20, 2021, the second Novartis Rheumatism and Immunity Summit Forum was successfully held in 12 cities including Beijing, Shenyang, Taiyuan, Xi'an, Shanghai, Hangzhou, Nanjing, Jinan, Guangzhou, Fuzhou, Chengdu, and Changsha.

The forum starts from the needs of patients with ankylosing spondylitis (AS), and covers the development of the diagnosis and treatment of AS disease in the medical insurance era to the solution of individualized diagnosis and treatment plans and the full management of AS disease.

Many experts in the field of rheumatism and immunology have expressed their opinions and heated discussions.
I believe that they can lead the majority of clinical rheumatology and immunology doctors to broaden their scientific research thinking, improve the level of clinical diagnosis and treatment, and promote the development of diagnosis and treatment in the entire AS field.

 Picture: The scene of the 2nd Novartis Rheumatism and Immunity Summit Forum (Opening Session) 1 Extract from the conference: Innovative drugs are included in medical insurance to promote the clinical diagnosis and treatment of AS.
AS is a chronic inflammatory disease involving the spine, sacroiliac and other joints.

The disease has a long course and is mostly insidious.
In the later stage of the disease, the affected joints and spine will appear bony rigidity, which seriously affects the patient's ability to move, and even leads to lifelong disability.

If you fail to get timely or improper treatment, the three-year disability rate is about 45.
5%, and the five-year disability rate is as high as 70%.

The AS indication for the first fully-human interleukin-17A (IL-17A) inhibitor Recucci Yumab ​​(trade name: Keshan Ting) was approved for listing in China in April 2020 and entered the National Medical Insurance Catalog in the same year.
Created a precedent for listing, that is, medical insurance.

It is believed that with the implementation of the medical insurance of Skucilizumab on March 1, 2021, a new era of biological treatment will be opened, bringing better clinical diagnosis and treatment solutions to more Chinese rheumatoid immunological patients.

The meeting invited Professor Wang Zhen, Director of the Microeconomics Research Office of the Institute of Economics of the Chinese Academy of Social Sciences, to discuss the "Policy Analysis on the Reform of Drug Purchase and Medical Insurance Payment Method" from his own specialty, and discussed the "surplus to oneself, overpayment" and public medical care.
The two major topics of institutional governance model conflicts and centralized drug procurement, drug payment standards and packaged payment, shared a lively and interesting medical insurance economics lecture for the doctors present.

Subsequently, the big coffees in each field discussed how innovative drugs into medical insurance promote the standard of clinical diagnosis and treatment of AS from several aspects.

1 Promotion 1: The overall change of the AS management ecosystem.
The entry of innovative drugs into medical insurance can improve the availability of drugs for the masses and at the same time improve the economic benefits of national medical care.

The entry of Skuchiyuumab into medical insurance has improved the recognition and diagnosis and treatment of AS disease, promoted the improvement of AS treatment goals, and improved the efficient use of domestic medical resources.

Many experts have also agreed with the view that "innovative drugs enter medical insurance and promote changes in the AS management ecosystem".

The 2010 International Association for the Assessment of Spondyloarthritis (ASAS)/European Alliance Against Rheumatism (EULAR) Guidelines[1] updated the AS treatment goals for the first time and proposed a treatment goal for comprehensive disease control, which indicates that the goal of early AS treatment has been controlled by symptoms Transform to the prevention of structural damage.

The MEASURE 1 study [2], a randomized, double-blind, placebo-controlled study showed that within 4 years of Skucilumab treatment, nearly 80% of patients had no imaging progression.

 Figure: The main results of the MEASURE 1 study Note: *Includes 23 patients, these patients were adjusted according to the plan determined by the investigator, starting from the 168th week, at different time points, the dose was increased from 75mg to 150mg of Skucilumab .

2 Promotion 2: Improvement of AS diagnostic criteria and treatment options Axial spondyloarthritis (axSpA) is an evolving disease.

The 1984 New York diagnostic criteria still in use today highlights the status of X-ray diagnosis of sacroiliitis in the diagnosis and guarantees specificity.

However, in the development of axSpA, it takes at least a few years from the first symptoms of inflammatory back pain to the appearance of radiological sacroiliitis, and it is already the middle and late stage of AS.

Experts believe that strengthening the early diagnosis of AS requires grasping the main clinical feature of AS-inflammatory low back pain, focusing on the use of the latest classification standards and strengthening early imaging diagnosis.

Among them, strengthening the diagnostic criteria for inflammatory low back pain is helpful for the early diagnosis of AS.

Preventing structural damage is an important goal of AS treatment.

The progression of AS disease includes the three links of osteitis-fat deposition-new bone formation, which ultimately leads to structural damage.

The IL-17A inhibitor, skukuzumab, can inhibit attachment site inflammation, reverse the fat deposition at the edge of the vertebral body, and inhibit the formation of osteophytes, thereby preventing the structural damage of AS.

Studies have shown that [3], after treatment with Skucilumab for 94 weeks, 30% of the vertebral marginal fat deposits with fat deposits at baseline disappeared.

 Figure: Evaluation of the efficacy of scocilizumab in the treatment of AS with fat deposition Note: FD+, fat deposition positive; FD-, fat deposition negative MEASURE 1 [2] The study found: scocilumab treatment to 104 weeks, baseline with ligaments 73% of 104 patients with osteophytes did not develop new ligament osteophytes.

 Figure: The main results of the MEASURE 1 study.
Note: The Modified Stokes AS Spine Score (mSASSS) is an indicator of changes in the structure of the spine.

If each specific involved vertebral body unit mSASSS ≥ 2, it can be regarded as the presence of new ligament osteophytes.

3 Promotion 3: Benefits of long-term treatment of AS AS is a long-term progressive disease.
After inflammation is controlled, structural progress is still going on.

AS requires long-term treatment, and as the treatment time is extended, the patient's outcome is better.

However, long-term treatment has challenges in terms of drug availability, safety, immunogenicity, long-term efficacy, and patient compliance.

And Skucilumab can overcome these problems one by one, so that patients can obtain long-term treatment benefits.

• Drug accessibility: Skuchiyuumab has been included in medical insurance and is a cost-effective long-term treatment option; • Safety: It performs well in terms of overall safety, hepatitis B, tuberculosis, and injection site reactions; • Immunogenicity: The incidence of anti-drug antibodies to Skuziyuumab is only 0.
7%; • Long-term efficacy: The effect of Skuziyuumab lasts for 5 years, which significantly delays the progress of imaging; • Compliance: The patients with Skuziyuumab have high compliance with each other.
The aspect satisfaction exceeds 90%.

A real-world survey based on the Internet [4] showed that patients' satisfaction in all aspects was more than 90% after Skuchiyuumab treatment.

 Figure: Real-world investigation and study of Skucilumab treatment satisfaction.
4 Promotion 4: SpA/AS's disease management.
Under the new patient-centered medical insurance situation, AS's disease management should start from before, during and after diagnosis.
Start with all aspects.

It also shows the whole-process management of AS.

Pre-diagnosis-The current situation of delayed diagnosis of AS in my country is grim.
In view of the late diagnosis of AS patients in my country, it is necessary to start from the reasons for the delayed diagnosis and work together with doctors and patients to improve this situation.

In terms of patients, disease education should be strengthened, and the development of appropriate Internet + auxiliary tools may help patients find diseases early.

As for doctors, the state is vigorously supporting the construction of rheumatology and immunology departments to make up for the lack of talents in rheumatology and immunology.

During diagnosis-during the transition period of diagnosis and treatment concepts and drugs, the treatment goal of AS has changed from symptom control to prevention of structural damage.

However, the rationality of the AS treatment plan needs to be further examined clinically based on the treatment goal.

The previous article has demonstrated the therapeutic effect of a new type of AS biologic agent-scocilizumab from the treatment mechanism and real-world research results.
With the inclusion of scocilizumab in medical insurance, the clinical practicability of the drug Greatly improve.

Post-diagnosis-low compliance under long-term standardized disease management To address the problem of low compliance of patients in long-term disease management, new disease management models can be explored, such as an extended medical service model that integrates doctors, nurses, and patients.

Among them, the establishment of the information network sharing platform is represented by the Intelligent Disease Management System (SSDM).

As of August 2019, more than 140,000 patients with rheumatism and immunology and 2,500 rheumatology and immunologists have registered to use the SSDM platform to help Chinese patients with rheumatism and immunology to establish personal electronic medical records and build a bridge of communication with doctors.

Studies have shown [5] that the use of SSDM self-evaluation can help patients achieve standard treatment.

After 6 months of follow-up, the proportion of patients meeting the treatment standard increased significantly from 27.
95% to 41.
08%.

The more frequently patients use the APP self-assessed AS disease activity score (ASDAS), the higher the proportion of patients who meet the standard treatment.

 Figure: SSDM intelligent disease management system helps patients achieve standard treatment 2 Rheumatism big coffee gathered, 12 city forum linkage The Novartis rheumatism and immunity summit forum is divided into 12 venues, including the main venue in Beijing, Shenyang, Taiyuan, Xi'an, Shanghai, Hangzhou, There are 12 cities in Nanjing, Jinan, Guangzhou, Fuzhou, Chengdu and Changsha.

At 12 conference venues, hundreds of FMCG experts gathered together to discuss the future direction of AS full-process management under the blessing of IL-17A inhibitors with hope for the development of AS.

 Picture: The twelve sessions of the 2nd Novartis Rheumatism and Immunity Summit Forum in Beijing's main venue.
The participating professors are: Professor Zhao Yan from Peking Union Medical College Hospital, Professor Wang Zhen, Director of the Microeconomic Research Office of the Institute of Economics, Chinese Academy of Social Sciences, and Peking Union Medical College The hospital includes Professor Li Mengtao, Professor Zhang Zhuoli from Peking University First Hospital, Professor Leng Xiaomei from Peking Union Medical College Hospital, Professor Mu Rong from Peking University Third Hospital, Professor Zhang Xuewu from Peking University People’s Hospital, and Professor Jiang Quan from Guang’anmen Hospital of China Academy of Chinese Medical Sciences.

In the Shenyang venue, the participating professors include: Professor Zhang Hongfeng from the First Affiliated Hospital of Dalian Medical University, Professor Gao Wei from the First Affiliated Hospital of Liaoning Medical University, Professor Zhang Rong from the First Affiliated Hospital of China Medical University, and Xiao Weiguo from the First Affiliated Hospital of China Medical University Professor Yang Pingting, the First Affiliated Hospital of China Medical University.

In the Taiyuan venue, the participating professors were: Professor Ru Jinli from the Second Hospital of Shanxi Medical University, Professor Shi Xiaofei from the First Affiliated Hospital of Heke University, Professor Li Hongbin from the Affiliated Hospital of Inner Mongolia Medical College, Professor Zhang Gailian from Shanxi Provincial People's Hospital, and the First Affiliated of Zhengzhou University Professor Zheng Zhaohui of the hospital, Professor Xu Ke of Shanxi Bethune Hospital and Professor Zhang Liyun of Shanxi Bethune Hospital.

In the Xi’an venue, the participating professors included: Professor Zhu Ping from Xijing Hospital of Air Force Military Medical University, Professor Wu Lijun from People’s Hospital of Xinjiang Uygur Autonomous Region, Professor Shen Haili from Lanzhou University Second Hospital, Professor Chi Shuhong from General Hospital of Ningxia Medical University, Xie from Xijing Hospital of Air Force Military Medical University Professor Rong Hua, Professor Yang Xichao from Xijing Hospital of Air Force Military Medical University, Professor Zhang Yan from Xijing Hospital of Air Force Military Medical University, Professor Zheng Zhaohui from Xijing Hospital of Air Force Military Medical University, Professor Li Xueyi from the Second Affiliated Hospital of Xi'an Jiaotong University, Professor Li Xiaoyan from Shaanxi Provincial People's Hospital and Xinjiang Uygur Autonomous Region Traditional Chinese Medicine Hospital According to Professor Rigetu.

In the Shanghai conference, the participating professors include: Professor Dongyi He from Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Professor Su Xiao from Shanghai Hospital of Traditional Chinese Medicine, Professor Jiang Lindi from Shanghai Zhongshan Hospital, Professor Dai Shengming from Shanghai Sixth People's Hospital, and Chen from Renji Hospital Affiliated to Shanghai Jiaotong University Professor Sheng, Professor Ye Shuang from Renji Hospital Affiliated to Shanghai Jiaotong University, Professor Wan Weiguo from Huashan Hospital Affiliated to Fudan University, and Professor Xu Huji from Shanghai Changzheng Hospital.

In the Hangzhou venue, the participating professors were: Professor Xue Jing from the Second Affiliated Hospital of Zhejiang University School of Medicine, Professor Chen Yong from Ningbo Second Hospital, Professor Li Suping from Wenzhou Central Hospital, Professor Zhou Li from Li Huili Eastern Hospital, Yuyao People's Hospital Professor Wei Wei, Professor Li Yasong from Zhejiang Provincial People's Hospital, and Professor Ye Qiao from Jiaxing Second Hospital.

In the Nanjing venue, the participating professors include: Professor Zhang Miaojia from Jiangsu Provincial People's Hospital, Professor Feng Xuebing from Nanjing Gulou Hospital, Professor Xu Xiaoyan from Zhongda Hospital Affiliated to Southeast University, Professor Lu Yan from Jiangsu Provincial Hospital of Traditional Chinese Medicine, and Guangci from the First Affiliated Hospital of Soochow University Professor Wu Jian of the branch and Professor Ji Wei of Jiangsu Provincial Hospital of Traditional Chinese Medicine.

In the Jinan venue, the participating professors were: Professor Shu Qiang from Qilu Hospital of Shandong University, Professor Zhu Yun from Weifang People's Hospital, Professor Hu Naiwen from Shandong Provincial Hospital, Professor Song Lijun from Shandong University Qilu Hospital, Professor Zhang Zhenchun from Linyi People's Hospital, Qilu from Shandong University Professor Liu Huaxiang from the hospital and Professor Li Shujie from the First People's Hospital of Jining City.

 In the Guangzhou venue, the participating professors were: Professor Dai Yu from Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Professor Li Juan from Southern Hospital of Southern Medical University, Professor Xiao Changhong from Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, and Professor Mei Yifang from the Second Affiliated Hospital of Southern University of Science and Technology , Professor Zhang Lijun from Shenzhen Hospital of Hong Kong University, Professor Lin Jinying from Guangxi District People's Hospital, Professor Cai Xiaoqing from Shunde Hospital of Guangzhou University of Chinese Medicine.

 In the Fuzhou venue, the participating professors include: Professor Lin He from Fujian Provincial Hospital, Professor Li Yinong from the Armed Police Hospital of Fujian Medical University, Professor Xu Shengqian from the First Affiliated Hospital of Anhui Medical University, Professor Wu Rui from the First Affiliated Hospital of Nanchang University, Fujian Medical University Professor Zheng Ling from the First Affiliated Hospital, Professor Yu Lian from Longyan First Hospital, Professor Wang Guosheng from Anhui Provincial Hospital, Professor Chen Renli from Ningde Hospital, Professor Chen Zhen from the Second Affiliated Hospital of Fujian Medical University, and Professor Zhang Shengli from Fujian Provincial Hospital.

 In Chengdu City, the participating professors include: Professor Liu Yi from West China Hospital of Sichuan University, Professor Zhu Jing from Sichuan Provincial People’s Hospital, Professor Liu Chongyang from the Third Affiliated Hospital of Chongqing Medical University, Professor Qing Yufeng from the Affiliated Hospital of North Sichuan Medical University, and No.
Professor Dang Wantai from the First Affiliated Hospital, Professor Yang Jing from Mianyang Central Hospital, Professor Xu Fang from Meishan People's Hospital, and Professor Liu Jianping from the Affiliated Hospital of North Sichuan Medical College.

 In the Changsha venue, the participating professors were: Professor Luo Hui from Xiangya Hospital of Central South University, Professor Dong Lingli from Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Professor Liu Sijia from Xiangya Hospital of Central South University, and Professor Zhang Shengtao from Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology , Professor Chen Xiaoqi from Zhongnan Hospital of Wuhan University, Professor Li Fen from the Second Xiangya Hospital of Central South University, Professor Zuo Xiaoxia from Xiangya Hospital of Central South University, and Professor Chen Jinwei from Xiangya Second Hospital of Central South University.

A Pilot Study to Assess the Feasibility of a Web-Based Survey to Examine Patient-Reported Symptoms and Satisfaction in Patients with Ankylosing Spondylitis Receiving Secukinumab.
Drugs Real World Outcomes.
2019;6(2):83-91.
[5] Xue, et al.
Presented at EULAR 2020.
Abstract Number SAT0646 Is a loading dose required for biologics in the past review? 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? The latest medical insurance drug list is implemented, IL-17A inhibitors will benefit more rigid patients! "Inflammation" must be lost, anti-inflammation knows how: IL-17A and inflammation