Managing The Immunomodulators Dosage and indication 'creep' with the new biologies to treat inflammatory diseases have payers enforcing strict utilization policies. Physicians counter that payers can't dictate treatment. With even more biologies on the horizon, and drag spend spiralling upward, both sides need to seek a middle ground. The question is how?

摘要

Lloyd F. Mayer, MD, has spent much of his career honing the cutting edge of medical care in immunology. Co-director of The Immunology Institute at The Mount Sinai Medical Center in New York, Mayer has been a lead player in the field just as the standards of care for inflammatory diseases such as rheumatoid arthritis (RA), multiple sclerosis (MS), Crohn's disease (CD), and psoriasis have undergone a major treatment shift with the arrival of a new generation of biologies.Treatment standards once revolved around a few key therapeutics that medical and pharmacy specialists knew well - azathioprine, methotrexate, corticosteroids, and 6-mercaptopurine - all used to suppress the body's immune system so it won't attack healthy tissue. Then, in the late '90s, the first biologies - etanercept (Enbrel) and infliximab (Remicade) for RA - gained U.S. Food and Drug Administration approval for treating inflammatory conditions, followed by a burst of biologic approvals as the new century dawned - adali-mumab (Humira) and certolizumab pegol (Cimzia) to treat RA and na-talizumab (Tysabri) for MS. CD, psoriasis, and psoriatic arthritis were subsequently added to the approval list for these drugs.