IAS 2022: Thinking Differently About Patients With Complex Cases

IAS brought together multispecialty experts to think outside the box and improve patient care. Attendees included rheumatologists, dermatologists, gastroenterologists, immunologists, nurse practitioners, nurses, physicians, and other health care professionals who manage and treat patients with immune-mediated inflammatory diseases (IMIDs). The senior advisors of the meeting were Leonard H. Calabrese, DO; Joel M. Gelfand, MD, MSCE; and Stephen B. Hanauer, MD. Additionally, the cochairs included Adam Cheifetz, MD; Joseph Merola, MD, MMSc; and Mital Patel-Cohen, MD.

Some of the themes covered at IAS this year included:

• Vaccine recommendations

• Treating patients with biosimilars

• Cardiovascular risks

• Care disparities

• COVID-19 and public health

• The burden of comorbidities

• Interdisciplinary management of immune-related adverse events

Perhaps the primary lesson gleaned from the US experience with the COVID-19 pandemic is that “we must be humble and willing to accept the fact that there is a lot we do not know yet,” said Michael Osterholm, PhD, MPH, during his keynote address.¹ Further, Dr Osterholm said, “If there was anything that was highlighted throughout this pandemic, it was the inadequacy of our understanding and response to the quality of indoor air. Early on, it was clear to many of us that what was occurring was aerosol-based transmission—the very tiniest of particles. But we got waylaid around so many issues around ‘hygiene theater’ such as plexiglass barriers that had no meaningful impact at all on viral transmission. We need to do so much more to improve air quality, but we have done so little to invest in this, especially in our schools.” Health care is also experiencing a major exodus of providers, he noted, and the same is true for essential worker safety. “These people are absolutely critical for what we must do. Look at the toll COVID took on workers in grocery stores, delivery, sanitation, law enforcement—how were they protected? In many cases poorly. Worker safety has to become a high priority. This is not the last of this virus or the last of pandemic viruses in general.”

During another session at IAS, Jonathan Kay, MD, discussed biosimilars and their place in treating IMIDs.² He defined a biosimilar as “a legitimate copy of a biopharmaceutical that no longer is protected by patent, which has undergone rigorous analytical and clinical assessment, in comparison to its reference product.” He added that these have been approved by a regulatory agency for biosimilar evaluation. At the end of his presentation, Dr Kay summarized by stating that all biologics can be varied considering drift and evolution occurring over time. He added that changing from bio-originators to their biosimilars in clinical trials has no correlation in the loss of efficacy, increased occurrence of adverse events, or immunogenicity. Additionally, he argued that the availability of biosimilars creates market competition that has decreased the cost of biopharmaceuticals.

Alexis Ogdie, MD, discussed the concept of treating the whole patient.³ She stressed that the patient is experiencing various things, and the disease is just one piece of their life. She said it is important to keep in mind all the other things that might be influencing patients’ health-related quality of life. During her presentation, she reviewed different comorbidities, including depression and anxiety, which are common conditions across rheumatic diseases. She explained the importance of managing central sensitization and highlighted the importance of aerobic exercise and exercise in general.

After attending IAS, participants were able to:

• Describe the relationship between the pathophysiology of chronic IMIDs and the mechanism of action of new and existing treatments.

• Outline the roles of current and emerging immunosuppressive, anti-inflammatory, and disease-modifying treatments for chronic IMIDs in treatment paradigms.

• Develop collaborative care guidance that improves the management of patients with multiple manifestations of immune-mediated disease.

For more on the event, please visit https://iasmeeting.com.

References

1. Osterholm M. How COVID-19 will change the world. Presented at: Interdisciplinary Autoimmune Summit; April 21–24, 2022; Virtual.
2. Kay J. Biosimilars in the treatment of IMIDs: a potential path to improved outcomes. Presented at: Interdisciplinary Autoimmune Summit; April 21–24, 2022; Virtual.
3. Ogdie A. The burden of inflammatory disorders—exploring comorbidities. Presented at: Interdisciplinary Autoimmune Summit; April 21–24, 2022; Virtual.