Philip J. Mease, MD

Mease discussed the expanding treatment landscape for PsA and how the field is integrating new biologics.

The Evolving Use of Biologics for PsA Care, with Philip Mease, MD

Biologics have grown to be a valuable option in the toolset for treating psoriatic arthritis (PsA), from first-generation TNF inhibitors to newer IL-17 and IL-23 inhibitors such as bimekizumab and risankizumab, respectively. Recent research has added more data to the literature on long-term efficacy, sequencing of therapies, and comparison studies of biologics.

Philip Mease, MD, Clinical Professor, University of Washington School of Medicine and Director, Rheumatology Research, Swedish Medical Center, has served as an investigator for pivotal trials evaluating a number of biologics including guselkumab and secukinumab.

® spoke with Mease to learn more about the trajectory that biologics have followed in the PsA field and how the field has continued to integrate more biologics into the treatment landscape. He also discussed different targets and recent research on new and upcoming biologics.

“We are now getting more and more choices, so as we strive to get patients into minimal disease activity state and maintain them there, even when we lose effect with one drug or one mechanism, we've now got others to be able to cycle to, and that's very helpful for us,” Mease told 

Relevant disclosures include AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Genentech, Janssen, Novartis, Pfizer Inc, Sun and UCB.

Walsh J, Merola J, Tillett W, et al. Bimekizumab Maintained Efficacy Responses in Patients with Active Psoriatic Arthritis: Up to 2-Year Results from Two Phase 3 Studies. Presented at the 2024 ACR Convergence. Washington, DC. 14-19 November.

Gordon, K.B., Blauvelt, A., Bachelez, H. et al. Long-Term Safety of Risankizumab in Patients with Psoriatic Disease: A Comprehensive Analysis from Clinical Trials. 

. Published online August 17, 2024. doi: 10.1007/s13555-024-01238-5

McInnes IB, Sewerin P, Sharaf M, Efficace M, Lavie F, Zimmermann M, Coates LC. Sustained response to guselkumab regardless of baseline characteristics in patients with active psoriatic arthritis and inadequate response to TNF inhibitors: results from the phase 3b COSMOS clinical trial. 

 2024 Dec 12;10(4):e004494. doi: 10.1136/rmdopen-2024-004494. PMID: 39672591.

Videos

The Evolving Biologic Landscape for PsA Care, with Philip Mease, MD

blood biomarkers to assist with diagnosing fibromyalgia, as well as other imaging modalities.

Future Developments in Fibromyalgia Treatment

This is a video synopsis/summary of a panel discussion involving Philip J. Mease, MD.

Despite progress in approved medications for fibromyalgia, there are significant unmet needs, such as lack of awareness among patients and clinicians. Education dissemination is crucial to bridge this gap. Additionally, the field anticipates advancements in new therapies, driven by ongoing pain research to unravel pain mechanisms and identify treatment targets. Philip J. Mease, MD, expresses hope for a future with additional treatments beyond the current pharmacological options. Advancements in diagnostic biomarkers, including blood biomarkers to distinguish fibromyalgia from autoimmune diseases, and improvements in neuroimaging for better identification of affected individuals, are also anticipated. These developments hold promise for enhancing understanding and addressing the complexities of fibromyalgia. The speaker emphasizes the importance of these future prospects in advancing fibromyalgia care.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Philip J. Mease, MD, highlights the potential of blood biomarkers to assist with diagnosing fibromyalgia, as well as other imaging modalities.

treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

Clinical Pearls for Clinicians Treating Fibromyalgia

Fibromyalgia may raise concerns for physicians regarding time consumption and emotional burden. Addressing these concerns requires upfront communication, explaining the neurobiology behind fibromyalgia to reduce stigma, particularly associated with psychological perceptions. With improved treatment approaches, managing fibromyalgia becomes more rewarding, especially when patients respond well to their treatment regimen. When patients have comorbid conditions, such as autoimmune diseases like rheumatoid arthritis or lupus, it's crucial to control both conditions concurrently. Employing current medications, biologics, and targeted synthetic disease-modifying drugs to manage inflammation and symptoms is essential. Simultaneously, acknowledging the presence of central sensitization or fibromyalgia is vital, fostering acceptance through patient-friendly language. Using terms like "central sensitization" can mitigate the stigma around fibromyalgia. Collaboratively pursuing nonpharmacological approaches alongside prescribed treatments enhances patient acceptance and makes the overall treatment approach more rewarding for both the physician and the patient.

Philip J. Mease, MD, discusses treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

Treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

Treatment Selection in Fibromyalgia

When introducing medications for fibromyalgia, choosing the appropriate one involves considering patient experiences and individual symptoms. For instance, if a patient emphasizes debilitating fatigue alongside pain, Milnacipran might be a preferred option due to its efficacy in addressing fatigue. However, patient-specific factors, such as high blood pressure concerns, may guide the selection of alternative medications like duloxetine or pregabalin.

Trial and error play a significant role in finding the most effective treatment, with adjustments based on symptom relief and tolerance of potential side effects. Combining medications, such as a small dose of pregabalin with an SNRI (serotonin and norepinephrine reuptake inhibitors) like duloxetine or milnacipran, is a strategy to simultaneously inhibit neuropeptides in the ascending pain pathway and boost the inhibitory side of pain signaling, potentially reducing side effects.

Beyond pharmacological interventions, a holistic approach to fibromyalgia care is crucial. This encompasses psychological counseling, regular conditioning exercises (such as swimming, which has shown benefits for musculoskeletal symptoms and fatigue), and improved sleep hygiene. Encouraging patients to explore alternative paths to physical activity, like swimming, emphasizes the importance of tailoring treatments to individual preferences and circumstances. In summary, comprehensive fibromyalgia care involves a thoughtful combination of medication management and multidisciplinary strategies to address the diverse aspects of this complex condition.

Philip J. Mease, MD

Articles