KOLs Predict: What Will the Next Year Bring? Save

Executive Editor's Note: In honor of our 1st anniversary at RheumNow, we asked many leaders, teachers and researchers in rheumatology to think big and provide overviews of where we've been [yesterday's feature] and where rheumatology is headed. The following contributions by many of our best Key Opinion Leaders (KOLs) was compiled after they responded to my request to predict what will happen in the next year. Specifically, I asked them for their thoughts on new discoveries, changes in healthcare, new drugs and their impact, changes in education, or who will win the World Series. Many thanks to my esteemed peers who are paving the way with their predictions. - JJC

My prediction is that the approach to and treatment of giant cell arteritis will be positively affected by approval of anti-IL-6 therapy. I predict that treatment courses will be shorter in patients with new disease, with significantly less glucocorticoid side effects. Further, this therapy will be useful in shortening the course of disease even in patients with established disease. I also predict that it will be akin to free climbing El Capitan in Yosemite to obtain coverage for the drug for most of our patients. Regrettably, the Twins are unlikely to win the World Series. Beyond that, it is of little matter who does (a deliberately provocative statement!).
--Eric L. Matteson, MD
Rochester, Minnesota

I’d predict that in 2016-17, we will start to see a change in the way that patients interact with rheumatology services. There will start to be departments establishing remote monitoring as a means to inform clinical consultations as well as triaging clinical appointments. This will be a significant change to clinical practice, whilst such regular patient-reported data will have huge benefits for observational research, too.
-- William G. Dixon, MRCP, PhD
Manchester, Great Britain

My predictions:

• Preliminary data on early-phase combination biologic treatment.
• Increased evidence on patient-derived data from Apps on wearables.
• New input from patients directly to Pharma on design of trials for approval and post-marketing.
• Baricitinib, Sirilumab, first adalimumab biosimilar(s)
• Changes in education: more online; fewer dinner talks; proliferation of non-branded, educational talks, increased emphasis on CME in state rheum societies.
• Who will win the world series: Washington Nationals defeat Cubs in NLCS and then defeat Houston in World Series.

--​Joel Kremer, MD
Albany, New York

I don’t think any major new things in RA. For SLE, the anti-interferons will come of age and they will have an impact. And the anti-IL17s will completely dominate SpA and PsA. In Europe, the EU will start taking action in the face of increasing concerns that extremely expensive cancer treatments (>100,000/year) do exist but are not available. This may lead to destabilization of the pharmaceutical marketplace. Baricitinib will be approved for RA and will have more impact than tofacitinib, but still a bit shy of expectations. Who will win the world series? I think it will be an American team.
--Ron van Vollenhoven, MD
Stockholm, Sweden

Two things:

• We are witnessing a birth of a new field of rheumatic and immunologic diseases as a byproduct of the remarkable, if not tectonic, advances in cancer immunotherapy with checkpoint inhibitors in the form of “immune related adverse events  or irAEs”. I predict that co-management of these patients with an array of autoimmune and autoinflammatory diseases will be become a new subspecialty interest of some practitioners crafted in a rheum-onc collaborative similar to rheum derm and others.
• ​I predict a new horizon of research into the role of physician empathy and advanced communications in the management of chronic disease where these will be assessed as primary drivers of PROs.  Rheumatology has largely ignored this burgeoning area of investigation.

-- Leonard H. Calabrese, DO
Cleveland, Ohio

Jack asked me to predict for the next year or two what I think will happen in rheumatology and other areas that affect rheumatologists. My disclaimer is I really don't know and sometimes my predictions are less than an educated guess or hunch, but here goes....

• The big advances in the next year will be in uncommon rheumatic diseases. This could include vasculitis and scleroderma.
• ​We will also see many molecules of novel pathways be trialed in phase II studies.
• ​We will rediscover old treatment (such as a research of COBRA type therapy in parts of Europe).
• ​A drug that may come to market: anti-sclerositin therapy for osteoporosis (although I have no insider knowledge) but I anticipate it will come and be another new way to treat osteoporosis.
• ​There are also many anti-cytokine trials in scleroderma but with monotherapy initial treatment and then rescue therapy with immune suppressants, the results will likely be modest at best. We know that in RA, which is easier to treat, monotherapy in general doesn't shine as well as combination therapy.
• ​If you have a president that plays to the masses, in the USA, I anticipate a negative impact in healthcare with respect to those with marginal means obtaining even less care. I think more joint replacements will be done 'minimally invasively' and that will improve outcomes and improve access for effective surgeries.
• ​FDA will continue to improve biosimilars and will perhaps develop a guidance document on interchangeability. Ixekizumab an IL-17 inhibitor will be approved for PsA.
• ​This and secukinumab (another IL-17 blocker) will eventually shift to more patients using this class of drugs first line in advanced therapeutics for PsO and PsA.
• ​I think in research there will be a shift to real world pragmatic trials that will help us to treat our patients better. The consent process will become easier for these studies and in North America we will begin to catch up to the Europeans who have led the area of pragmatic trials in RA for years.
• ​Changes in education - no idea what will happen to CME in the USA. I don't know if 'rubber chicken dinners' (pharmaceutical sponsored talks with pre approved slides that cannot be deviated from) will flourish or fall. However, there will be a move to more university accredited poly-pharma sponsored events.
• ​I have no idea who will win the world series but it won't be the Montreal Canadians (as they are a hockey team). I also can't even dream of who will win your election.

--- Janet Pope, MD, MPH, FRCPC
London, ON, Canada

Rheumatologists will increasingly be Tiered by third party payers and think seriously about ways to provide value-based care.
-- James R. O’Dell, MD
Omaha, Nebraska

This will be the year of the biosimilars, arguments evaporate in light of savings!
-- Paul Emery, MA, MD, FRCP  
Leeds, Great Britain

My prediction is that once and for all it will be shown that spondyloarthritis is a sh!tty business - gut microbiome will be proven to be an important etiological factor in SpA.
-- Atul Deodhar, MD, MRCP
Portland, Oregon

For New discoveries/associations:
1. The gut biome will be seen as a factor for the development of rheumatic diseases like it has been shown for the development of diabetes
2. New therapies will be even more targeted towards types of diseases, e.g., we willl discover new drugs will be more effective in treating seronegative RA vs. seropositive RA
3. New highly effective treatment for erosive OA will be found
4. New therapeutic targets for SLE subtypes will be studied based on Dr. Pascual's study

Changes in healthcare:
1. More doctors leaving practice due to dissatisfaction and low reimbursements
2. More specialists joining concierge medicine
3. More physician extenders seeing patients (nurse practitioners/physician assistants); doctors will assume more of a managerial position than seeing patients
4. More prior authorizations

FDA approvals:
1. The biogenerics approved will bring costs of biologics down but will not affect tax rates
2. Tocilizumab will be approved for scleroderma with orphan drug status

Changes in Studies/education:
1. The 2nd wave initiative will take effect: more studies will be offered to look at drugs in women and pregnancy
2. FDA pregnancy labeling may provide more confusion than help
3. Big data will be the only kinds of studies that will hold clout (big numbers, mega-million patient years)
4. There will be more robotic KOLs (blog coming soon)

-- Kathryn Dao, MD
Dallas, Texas