No Patient Left Behind: Building the Case for Early RA Therapy
Clinical Update 3: From the ACR 2009 Annual Scientific Meeting

Medium: Podcast (with RSS Feed)
Accreditation Expired

Credit Hours

Physician CME: 0.50
Physician Assistants Hours: 0.50

Initiative Overview

This Podcast is part of the Initiative No Patient Left Behind: Building the Case for Early RA Therapy which consists of multiple, sequential CME activities.

  • The first educational activity in this Initiative was a live meeting in Philadelphia and simultaneous webcast. This is now available as Webcast On-Demand in which experts in rheumatology discuss scientific evidence and its application to clinical practice through a case series.
  • Podcast is the next learning step in this Initiative. It focuses on the latest research related to undifferentiated arthritis and early rheumatoid arthritis. Podcast consists of 3 educational activities:
    • Clinical Update 1: From the EULAR Congress 2009
    • Clinical Update 2: From the Literature 2009
    • Clinical Update 3: From the ACR 2009 Annual Scientific Meeting

Activity Overview

Clinical Update 3 highlights research related to early rheumatoid arthritis presented at the 2009 American College of Rheumatology Annual Scientific Meeting that was held in October 2009 in Philadelphia, Pennsylvania. The ACR meeting featured current issues, hot topics, and the latest research related to rheumatic diseases.

In this episode, Dr. Schiff and Dr. Massarotti discuss the latest results from three clinical trials that compared the use of conventional DMARDs and biologics for the treatment of early RA.

  • Results from the TEAR and SWEFOT trials are first discussed. The TEAR trial compared the ACR response in patients with early RA who began therapy with immediate combination therapy versus initial methotrexate monotherapy with step-up at 6 months. Combination therapy consisted of triple DMARD therapy or methotrexate plus etanercept.
  • The SWEFOT trial compared the addition of anti-TNF therapy versus triple DMARD therapy in patients who initially fail methotrexate therapy. This update compared the radiological progression over 2 years with these two therapeutic strategies.
  • Lastly, the AGREE trial is discussed, which compared abatacept plus methotrexate versus methotrexate alone for the treatment of early erosive RA in methotrexate naïve patients.

Educational Overview

There has been remarkable progress in the therapy of rheumatoid arthritis (RA), related in part to a better understanding of the pathogenesis of this disease. The development of several effective and safe novel therapeutic options has contributed to a shift in the treatment paradigm that now focuses on early and aggressive management supported by increasing evidence of the clinical and radiographic benefits of initiating DMARD treatment early in the course of the disease. These benefits include a reduction in the risk of associated comorbidities, in particular cardiovascular disease. Clinical remission has become an attainable goal and improved patient quality of life is now an expected outcome. All these developments have made “no patient left behind” a definite possibility.

Against this backdrop, healthcare professionals caring for patients with early RA need to be armed with the latest knowledge about ways in which to individualize therapy to achieve patient-specific goals.

Target Audience

This educational activity has been developed for rheumatologists, physician assistants, and other healthcare professionals responsible for the management of patients with early RA.

Purpose Statement

The purpose of this activity is to educate rheumatologists, physician assistants, and other healthcare professionals responsible for the management of patients with early RA on the benefits of aggressive, early RA therapy and patient-centered management to achieve customized goals. With this knowledge, healthcare professionals will be able to tailor therapy to meet patient-specific goals making “no patient left behind” a reality.

Learning Objectives

After completing this educational activity, learners should be able to:

  • Recognize the benefits of pharmacotherapy for early rheumatoid arthritis (RA), including undifferentiated arthritis
  • Compare the safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologic agents for the treatment of RA


Elena M Massarotti, MD

Associate Professor of Medicine, Harvard Medical School
Co-Director, Center for Clinical Therapeutics
Division of Rheumatology
Brigham and Women’s Hospital
Boston, MA

Michael H Schiff, MD

Clinical Professor of Medicine, Rheumatology Division
University of Colorado School of Medicine
Denver, CO



Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship of Center for Independent Healthcare Education (Center) and Vemco MedEd. Center is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: Center designates for this activity a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Physician Assistants

American Academy of Physician Assistants accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME. Physician assistants may receive a maximum of 0.50 hours of Category I credit for completing this activity.

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Disclosure of Conflict of Interest

Center for Independent Healthcare Education requires faculty, planners, and others who are in a position to control the content of continuing education activities to disclose to the audience any real or apparent conflict of interest related to the activity. All identified conflicts of interest are reviewed to ensure fair balance, objectivity, and scientific rigor in all activities. The faculty is further required to disclose discussion of off-label uses in their presentations.



Michael H Schiff, MD

Advisor/consultant: Abbott, Bristol-Myers Squibb, Amgen, UCB, Novartis, Bayer, Roche, and Array BioPharma
Promotional speaker’s bureau: Abbott

Elena M. Massarotti, MD

Grant/research support: UCB, Genentech, and EMD Serono
Advisor/consultant: Bristol-Myers Squibb, Pfizer, UCB, Genentech, and EMD Serono

Planning Committee Members

Employees of Center for Independent Healthcare Education and Vemco MedEd have no relevant financial relationships to disclose.

Disclosure of Off-Label Use

During this podcast episode, the off-label use of antirheumatic agents is not discussed.

Joint Sponsorship

This activity is jointly sponsored by Center for Independent Healthcare Education and Vemco MedEd.

Commercial Support

This activity is supported by an educational grant from Bristol-Myers Squibb.


There is no fee to participate in this educational activity.

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Copyright Statement

Copyright © 2009 Vemco MedEd, LLC. All Rights Reserved.
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The opinions expressed in this educational activity are those of the faculty and do not reflect the views of Center for Independent Healthcare Education (Center) and Vemco MedEd. This educational activity may discuss off-label and/or investigational uses and dosages for therapeutic products/procedures that have not been approved by the United States Food and Drug Administration (FDA). Center and Vemco MedEd do not recommend the use of any product/procedure outside of the labeled indications. A qualified healthcare professional should be consulted before using any therapeutic product/procedure discussed. Learners should verify all information and data before treating patients or employing any therapies described in this continuing education activity. Please refer to the official prescribing information for each product/procedure for approved indication, contraindications, and warnings.

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