Rheum Round-up: Humira® Top Contributor for Increased Drug Prices, CBD Guidelines, and more

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read about Humira’s cost increase, the Arthritis Foundation’s CBD guidelines, the link between hip arthroplasty and cancer, and the prevalence of osteoporosis in knee arthroplasty patients.

AbbVie’s blockbuster arthritis drug Humira® (adalimumab) took the number one spot on a list of seven drugs collectively responsible for a $5.1 billion jump in U.S. medical spending, despite the fact that no new research or evidence over the past three years has supported these increased prices, according to a new report. The net change in the price of Humira increased by 15.9%, which equated to a $1.857 billion increase in spending. Humira’s 2018 sales revenue also largely outpaced that of other drugs at $13.685 billion—a 19.1% eight quarter wholesale acquisition cost (WAC) change. 2018 sales revenue for the second drug on the list, Revlimid®, was $6.469 billion.

The Arthritis Foundation recently issued guidelines for the use of cannabidiol (CBD) for pain among patients with arthritis. Although CBD remains an understudied treatment avenue for the management of rheumatic and musculoskeletal conditions, patients are still exploring its use on their own. A study earlier this year found that more than half of arthritis patients have tried CBD and/or medical marijuana for pain relief. Three experts were consulted: Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan; Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center; and Mary Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec.

Patients who underwent total hip arthroplasty (THA) for osteoarthritis (OA) of the hip did not have a greater risk for cancer in a recent study. Researchers compared 126,276 patients who underwent a cemented THA between 1992 and 2012 to 555,757 patients who did not undergo surgery. For operative patients, follow-up began on the day of the index surgery; nonoperative patients matched to the THA cohort were given the same follow-up start day. Compared to the control group, THA patients had a slightly lower adjusted risk for cancer (hazard ratio [HR] 0.97; confidence interval [CI] 0.95-0.99). The operative cohort only had a significantly increased risk for one type of cancer—skin melanoma (HR 1.15; CI 1.05 ‐ 1.24).

The prevalence of osteoporosis among patients undergoing total knee arthroplasty (TKA) may be higher than previously believed because it may go unrecognized in this population, according to recent findings. A total of 30 patients—15 each of males and females—aged between 59 and 80 (mean, 67.9) years were included. Patients had no known history of bone health issues and underwent routine dual-energy X-ray absorptiometry between two and five (average 3.2 ± 0.8) years following primary unilateral TKA. The researchers posited that the 36.7% of patients meeting the National Osteoporosis Foundation criteria was a significant portion, and also suggested that this may be “a conservative estimate” because the study only included patients without a history of bone health problems.