Allan Gibofsky, MD, JD, attending rheumatologist and co-director of the Clinic for Inflammatory Arthritis at Hospital for Special Surgery, in New York City, met with Rheumatology Advisor to discuss the recent Food and Drug Administration (FDA) approval of adalimumab for the indication of noninfectious uveitis.
FDA approval was granted after reviewing results of 2 clinical trials, Efficacy and Safety of Adalimumab in Patients With Active Uveitis (VISUAL l, ClinicalTrials.gov Identifier: NCT01138657) and Efficacy and Safety of Adalimumab in Subjects With Inactive Uveitis (Visual II, ClinicalTrials.gov Identifier: NCT01124838). It was found that adalimumab decreased treatment failure (TF) in adults with both active and controlled non-infectious intermediate, posterior, or panuveitis.
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The US Food and Drug Administration (FDA) recently approved adalimumab for noninfectious uveitis, which is primarily an ophthalmologic disease. As a rheumatologist, I do not treat an ophthalmologic disease unless it is a manifestation of a rheumatologic condition.
As such, I am very comfortable treating patients with ophthalmologic diseases in concert with and in partnership with an ophthalmologist, just as I am comfortable treating patients with inflammatory bowel disease who have arthritis in concert or in partnership with a gastroenterologist, since I neither manage nor assess the efficacy of a particular treatment in the primary condition.
So, would I be comfortable if a patient walked in to my office with a prescription in her hand indicating, “Noninfectious uveitis … please treat”? Of course not. However, if this were a patient with a noninfectious uveitis as part of an underlying rheumatic condition that I were participating in the care of, then I would have no qualms about treating that patient. Indeed, many of my colleagues do just that. One of my colleagues here at Hospital for Special Surgery has a particular interest in ophthalmologic conditions and does that regularly.
So, I think we will see partnerships between nonbiologic-prescribing specialists and biologic-prescribing specialists, but in situations where there are opportunities for shared care and the nonbiologic-prescriber is directly involved in assessing the clinical status of the disease.