Medical Rationale: Autoimmune diseases

The consequence of autoimmune diseases, in which the body's immune system destroys its own cells and tissues, is often progressive disability. They affect ca. 3.5% of the population, 75% of whom are women. According to the European Parliament report "Autoimmune Diseases - Modern Diseases," there has been a significant increase in the incidence of these diseases over the past decade.

Psoriasis and AD

Prof. Irena Walecka, consultant of the Mazovian province in dermatology and venereology, who heads the Dermatology Clinic of the PIM MSWiA in Warsaw, stressed that thanks to the changes introduced by the health department, the psoriasis treatment program is truly ideal. - We have 11 drugs, one new one included since March this year, the criterion for skin lesions has been lowered, which allows modern treatment of moderate psoriasis, instead of from the age of 6 we can treat children from the age of 4, the therapy is available for pregnant and breastfeeding women, there is the possibility of remote consultations. The treatment program is patient and doctor friendly," she concluded.

Prof. Witold Owczarek, head of the Department of Dermatology at WIM - PIB in Warsaw, spoke about the needs of patients suffering from atopic dermatitis (AD) - a chronic, recurrent and incurable dermatosis that occurs in both children and adults.

Currently, patients with severe forms of the disease have access to innovative therapy, while patients with moderate forms could also benefit clinically. The latest treatment option for AD is baricitinib. It is the first targeted synthetic drug in oral form. - The benefits of early treatment of the disease at a lower stage translate into an adequate, effective, long-lasting response to therapy, Prof. Witold Owczarek stressed.

Experts pointed out that for adults with severe AD, who experience itching and pain 24/7 and against whom all therapeutic options available in Poland, i.e. topical corticosteroids or calcineurin inhibitors, have proved ineffective, the only salvation is dupilumab, which allows to reduce bothersome itching and take control of the disease in a short period of time. Both patients and doctors in Poland are waiting for this therapy.

Type one diabetes

Prof. Leszek Czupryniak, head of the Department of Diabetology and Internal Diseases at WUM, stressed that recently, thanks to the decisions of Deputy Minister Maciej Miłkowski, the situation of patients with type 1 diabetes has significantly improved. - Diabetology pediatrics in Poland offers a world-class service and Polish children are the best compensated in Europe. Unfortunately, insulin pumps are reimbursed only until the age of 26, and patients who have used them lose this opportunity. It would be good to enable them to continue. On the other hand, continuous glycemic monitoring systems are reimbursed for everyone taking insulin 3 times a day, and this is the best availability in Europe, he mentioned.

Piloting comprehensive care in early arthritis

About 400,000 people in Poland suffer from rheumatoid arthritis. RA is mistakenly perceived as a disease of the elderly. Meanwhile, it is usually diagnosed between the ages of 30 and 50, but can occur earlier. What is important in RA is the earliest possible diagnosis and the inclusion of effective treatment. According to the recommendations of scientific societies, in the case of rheumatoid arthritis, it is recommended to make a diagnosis within a maximum of 12 weeks after the onset of symptoms. In Poland, RA is diagnosed after 35 weeks on average, and only 10-20% of patients have a diagnosis established and treatment incorporated within 12 weeks. Prof. Brigid Kwiatkowska, who oversees the pilot of comprehensive specialized care for patients with early arthritis, stressed that it responds to the gigantic diagnostic backlog. It covers 11 provinces, which will make it possible to assess its clinical and economic effectiveness. - The success is the creation of a patient database on the basis of the pilot, into which data will be automatically sucked, she informed. The ministry estimates that up to 4,500 patients will benefit from the diagnostic module, while 2,500 will benefit from the care module. Patients participating in the pilot will be able to count on the year-long care of a multi-specialist team.

Juvenile idiopathic arthritis

Experts pointed out that baricitinib is only available for patients with high disease activity. Meanwhile, it is important that patients have access to innovative treatments already at a low stage of inflammatory joint disease, since there is a high risk that those not treated with innovative drugs will soon develop a more advanced disease stage with high disease activity. When innovative treatment is applied to them, it is possible to stop the disease and function normally. Prof. Zbigniew Żuber, head of the Department of Pediatrics at KAAFM, stressed that in all inflammatory rheumatic diseases it is important to diagnose as early as possible and include effective treatment. - There is a shortage of innovative drugs and we are calling for faster access. Before a patient turns 18, he or she is often ill for 16 years. The range of treatment options should be as broad as possible. After all, there are intolerances to many drugs, and lack of treatment means abnormal development, emotional problems, depression resulting from the inflammatory process going on in the body," he mentioned.

Lupus erythematosus

Systemic lupus erythematosus (TRU) is a disease in which the immune system attacks healthy tissue. It leads to chronic inflammation of tissues and organs. Most sufferers are women, and mortality is 3 times higher than in the general population. Symptoms include weakness, fatigue, a subfebrile state, weight loss and a characteristic butterfly-shaped erythema on the face. Treatment is aimed at controlling symptoms and improving quality of life. Currently, therapy for lupus, which causes chronic inflammation in many tissues and organs, mainly uses glucocorticosteroids, the use of which is associated with the risk of serious side effects. - We are counting on the reimbursement of anifrolumab," noted Prof. Brigid Kwiatkowska. When glucocorticosteroids are used, about 70% of patients experience a re-exacerbation of the disease, despite achieving an initial state of remission or low disease activity. Long-term use can damage organs.

Myasthenia gravis

Myasthenia gravis is an autoimmune disease of the postsynaptic part of the neuromuscular junction. Its course is characterized by a wide variability of symptoms from mild ocular symptoms to a life-threatening condition such as myasthenic breakthrough. Treatment should take into account the severity of symptoms, age or other health problems of the patient. Prof. Anna Kostera-Pruszczyk, who heads the Department of Neurology at UCK WUM, recalled that the standard myasthenia gravis therapy currently available in Poland, which includes glucocorticosteroids, immunsupressants or immunomodulatory drugs, may not be sufficient to permanently control the symptoms of the disease, and is additionally associated with debilitating side effects. - Among the 9,000 patients - children and adults - with active myasthenia gravis, 40-50% - thanks to treatment - will achieve remission, but the rest will have chronic disease. Meanwhile, the disease can start at any period of life. These patients are learning, studying, starting families, working. Therefore, access to effective therapies is very important," she pointed out. The reimbursement expectation is rawulizumab. - The drug protects the muscle from a massive antibody attack that leads to the physical destruction of an important part of the muscle, she pointed out. Thanks to its targeted mechanism of action and inhibition of abnormal activity of the complement system, it provides early and long-lasting treatment without the troublesome side effects often seen with other treatments.

Multiple Sclerosis

Prof. Konrad Rejdak, president of the Polish Neurological Society, who heads the Department of Neurology at the Medical University of Lublin, spoke about diagnostic and therapeutic advances in MS. He stressed that it has been possible to consolidate treatment programs, which are being carried out by 130 patients taking therapy of all lines. A novelty is the introduction of drugs with higher efficacy to the first line. - There is still a prolonged diagnostic pathway or a wait for treatment after diagnosis. Unfortunately, funding for operating the programs has not increased significantly. In addition, the system should not force the patient to make visits that are not warranted and when they can take medication at home, he pointed out.

Inflammatory bowel disease

Attorney Piotr Mierzejewski, co-chairman of the Health Expert Committee at the PRO, spoke about the problems of patients with inflammatory bowel disease. These patients need a map of the location of toilets on their way to work, and frequent use of toilets at work is seen as a sign of laziness and an attempt to avoid professional duties. - Misunderstanding on the part of the public is enormous and is due to ignorance. That is why awareness campaigns on autoimmune diseases are needed," he appealed.

Prof. Ewa Mojs, who heads the Department of Clinical Psychology at Karol Marcinkowski University in Poznan, drew attention to the threats to the mental condition of patients with autoimmune diseases and the possibilities of counteracting their mental health crises. - It is worth including psychologists in therapeutic teams, which improves patients' condition and adherence, i.e. adherence to therapy, compliance and adherence to medical recommendations, and acceptance of agreed-upon therapies, she argued.

Prof. Ewelina Nojszewska of the Department of Applied Economics at the Warsaw School of Economics drew attention to the indirect costs of autoimmune diseases, which exceed the direct ones and are often overlooked in treatment decisions.