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| Interview Transcript - Rheumatologist #3 | |
| Date: October 20, 2025 | |
| Interviewee Type: HCP (Rheumatologist) | |
| Location: Private Practice | |
| Years in Practice: 10 years | |
| Interview Content: | |
| Interviewer: What's your approach to prescribing biologic therapies for rheumatoid arthritis? | |
| HCP: I typically start with conventional DMARDs like methotrexate first, per the guidelines. But if patients aren't achieving low disease activity within 3-6 months, I move to biologics. "The challenge is there are now so many options - TNF inhibitors, IL-6 inhibitors, JAK inhibitors, B-cell depletion agents." The evidence shows they're all pretty comparable in terms of efficacy, so it often comes down to patient preference, insurance coverage, and safety profile. | |
| Interviewer: How do patients respond when you recommend an injectable biologic? | |
| HCP: It's really mixed. Some patients are terrified of needles and beg for an oral option, which is why the JAK inhibitors have been so popular. Other patients actually prefer injections because it's something they do themselves at home every week or two, versus daily pills. I'd say about 70% of my patients adapt well to self-injection with proper training. | |
| Interviewer: What about the recent safety concerns with JAK inhibitors? | |
| HCP: The FDA's black box warning definitely changed the conversation. "I'm much more cautious now, especially in older patients with cardiovascular risk factors or history of malignancy." I probably prescribe JAK inhibitors for maybe 20-30% of patients who need a biologic, whereas two years ago it was closer to 50%. I'm doing more TNF inhibitors again, even though they're injectables. | |
| Interviewer: How long do you typically try a biologic before deciding if it's working? | |
| HCP: I give it a good 3-4 months. Biologics don't work overnight. I see patients back at 6 weeks, 12 weeks, then quarterly if they're stable. I'm looking for reduction in tender and swollen joint counts, improvement in inflammatory markers like CRP, and most importantly, how the patient feels functionally. Can they open jars, button shirts, work, exercise? If I'm not seeing meaningful improvement by 3-4 months, I'll switch to a different mechanism of action. | |
| Interviewer: What percentage of your patients fail their first biologic? | |
| HCP: About 30-40% either don't respond adequately or lose response over time. Then we're into second-line, third-line biologics. Some patients have tried 4-5 different biologics before finding one that works. "It's really trial and error, which is frustrating for everyone. I wish we had better biomarkers to predict who's going to respond to what." | |
| Interviewer: Are there any emerging therapies you're excited about? | |
| HCP: The bispecific antibodies in development are interesting. Also, there's more focus on achieving remission rather than just low disease activity. I'm seeing more aggressive treat-to-target strategies, which I think is the right direction. The data shows that if you can get patients to true remission early, you can potentially prevent long-term joint damage. | |
| Interviewer: What barriers do you face in getting patients to remission? | |
| HCP: Insurance is number one. "Prior authorization for biologics can take 2-4 weeks, and during that time, the disease can progress." Also, cost-sharing. Even with insurance, some patients have copays of $100-200 per month for biologics. And then there's the subset of patients who are just resistant to multiple therapies. Maybe 10-15% of my RA patients never achieve good control despite trying everything. | |