JointHealth™ express   February 9, 2012

Good news for those living with rheumatoid arthritis and systemic juvenile idiopathic arthritis

It’s always nice to hear good news in the middle of winter, so Arthritis Consumer Experts is happy to report on positive changes regarding medications for those living with rheumatoid arthritis and systemic juvenile idiopathic arthritis.

Good news for Quebec residents
As of this month, it has become easier to get access to rituximab (Rituxan®) for the treatment of moderate or severe rheumatoid arthritis (RA) in Quebec. Rituximab was first added to the provincial medication reimbursement plan in 2008, making it available to people on a case-by-case basis.

The changes to the criteria now mean the following:
  • Rituximab can either be taken with methotrexate or leflunomide, if methotrexate is not tolerated. Previously, it could only be taken with methotrexate, which meant that people that had to take another form of disease modifying anti-rheumatic drug (DMARD), would not be eligible for getting coverage for rituximab.
  • When rituximab was originally added to Quebec’s List of Medications, the criteria stated that a request for continued treatment using the medication had to be effective within six months of the last injection, followed by a loss in effectiveness. Now, patients no longer have to wait for it to stop working before being able to continue getting treatment with rituximab.
  • After the initial treatment, requests for continuation are allowed for a minimum of 12 months and a maximum of two treatments, rather than for only 6 months and one treatment which were all that were allowed until this month.
  • Before, people with RA had to fail an anti-TNF biologic before they could switch to rituximab, but now biologics that work using a different mechanism of action can be tried instead, and be unsuccessful, before a patient can have access to rituximab. That is, if you have been on a biologic that did not work, you no longer have to first try the anti-TNFs (infliximab, etanercept, and adalimumab) before getting an opportunity to use rituximab.
This is great news because now it means that getting access to reimbursement for this medication is simpler and there are more treatment options for those living with rheumatoid arthritis.

Click here to view the most up-to-date version of ACE's Report Card on provincial formulary reimbursement listings for biologic response modifiers.

What is rituximab?
Rituximab belongs to the class of medications called "biologics" (short for biologic response modifiers), which target the specific pathways responsible for causing inflammation and joint destruction. It targets B-cells to treat the underlying disease process and so reduces the signs and symptoms of rheumatoid arthritis. B-cells are white blood cells that originate from stem cells in bone marrow. Targeting B-cells prevents them from becoming plasma cells which create antibodies that, in someone with RA, attacks their joints.

Also, this month: Good news for Canadian kids
Out of the one in 1000 children who get diagnosed with juvenile idiopathic arthritis (JIA), 10 percent have the systemic (whole body) form of the disease. It is not only one of the rarest forms of JIA, it is also the most difficult to manage and very painful. Children with systemic onset JIA present quite ill with high fevers, rash, and organ inflammation along with joint inflammation.

Systemic juvenile idiopathic arthritis (sJIA) can lead to life long disabilities, slowed growth, osteoporosis, and sometimes life-threatening complications.

Fortunately, at the beginning of this month Health Canada approved tocilizumab (Actemra®) for the treatment of systemic juvenile idiopathic arthritis (sJIA).

The next step in the process toward provincial reimbursement of the medication is having the Canadian Agency for Drugs and Technologies in Health (CADTH) recommend the medication be listed on formularies in Canada’s publicly funded drug plans (except Quebec). The CADTH’s Common Drug Review is currently reviewing the medication. Following that, provinces may start to add the medication to their formularies.

Tocilizumab is the first medication approved by Health Canada that specifically treats systemic JIA.

What is tocilizumab?
Tocilizumab is a biologic that specifically inhibits or slows down the body's production of IL-6, a protein that when over produced promotes joint inflammation and damage, fever, anemia, slowed growth, and osteoporosis. The medication is effective for treating the symptoms and the underlying disease process of sJIA.

Reminder: Tell us what you think
We are very pleased to report that a great number of you responded to the Arthritis Consumer Experts’ (ACE) 2012 JointHealth™ Programs Satisfaction and Interest survey. Your input on our JointHealth™ programs and related projects has been positive and constructive. Thank you!

From your feedback, we have a greater insight into what programs are the most important to you and what you would like to see us focus on in future projects.

For those of you, who have not yet had a chance to fill out our survey, there is still time, but the deadline is February 10, 2012.

Click here to take the survey.