• Discuss issues related to sub-optimal responses to TNF antagonists in the treatment of rheumatoid arthritis, including an estimate of their incidence
• Provide a working definition of a sub-optimal response and/or a failure with TNF antagonist therapy in rheumatoid arthritis
• Describe the immunological basis for therapy with newer classes of therapy, such as co-stimulatory molecules and B-cell depletion
• Outline treatment strategies which may be used to overcome a sub-optimal response or failure to TNF antagonists in the treatment of rheumatoid arthritis

Date of Release and Expiration
This course was released on January 13, 2006 and will expire on January 13, 2007. Credit cannot be awarded after this date.

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Copyright 2006, Johns Hopkins University School of Medicine. All rights reserved.

Dr. Bingham is an assistant professor of medicine with a primary appointment in the Division of Rheumatology and a secondary appointment in the Division of Allergy and Clinical Immunology. He received his MD from Columbia University, where he also completed internship and residency training in internal medicine. He trained in clinical rheumatology, as well as in allergy and clinical immunology at the Brigham and Women’s Hospital in Boston. Dr. Bingham completed additional postdoctoral fellowship training at Harvard Medical School and served as an attending rheumatologist and allergist/immunologist at Brigham and Women’s and at Massachusetts General Hospital. He was on faculty at NYU-Hospital for Joint Diseases from 1999 through 2004 where he founded and directed the Peter D. Seligman Center for Advanced Therapeutics, a dedicated rheumatology clinical and translational research unit. He was recruited to join the faculty as a member of the arthritis center at Johns Hopkins in 2005.

Dr. Bingham received the Dorothy Goldstein Young Scholar Award from the New York Chapter of the Arthritis Foundation and is the recipient of an Arthritis Investigator Award from the national Arthritis Foundation. He has served as principal investigator for multiple Phase II and III clinical trials for rheumatoid arthritis, psoriatic arthritis and osteoarthritis and was a site principal investigator for the multicentered NIH Glucosamine Arthritis Intervention Trial (GAIT). He has been involved in more than 30 Phase I–IV clinical trials and registries for patients with rheumatic diseases. Dr. Bingham has served on an expert panel for clinical research at the NIH-NIDCR, on an NIH-NIAMS special emphasis panel study section and has served as a reviewer for rheumatology journals including Arthritis and Rheumatism, Arthritis Research and Therapy and Journal of Rheumatology. He has authored more than 18 articles and reviews on topics in inflammation, mast cell biology, rheumatoid arthritis, psoriatic arthritis and osteoarthritis, six book chapters, including one in the Primer on Rheumatic Diseases, several topics in UpToDate in Medicine and more than 28 abstracts presented at national and international scientific meetings. He has worked with several pharmaceutical companies in clinical trial design and data analysis for OA and RA investigational therapeutic agents. He is active in the American College of Rheumatology, serving on the Professional Meeting Planning Committee; chairman of the 2006 Spring Rheumatology State-of-the-Art Meeting; the Innovative Therapies in Autoimmune Diseases Planning Committee; RA Clinical Therapeutics Abstract Selection Committee; and chairman of the RA Study Group. He has worked with the Group for Research in Psoriasis and Psoriatic Arthritis (GRAPPA) and has participated in biennial OMERACT meetings, chairing a Special Interest Group to evaluate the comprehensive evaluation of single joints in clinical trials of emerging therapeutics including gene therapy. He currently serves as the director of the Johns Hopkins Arthritis Website (www.hopkins-arthritis.org).

His interests are in novel therapeutic agents for the treatment of inflammatory arthritis and osteoarthritis, as well as in chronic autoimmune urticaria. He is actively involved in studies to determine risk factors for imminent progression in osteoarthritis. He is directing another project in collaboration with dental investigators to understand shared disease mechanisms in rheumatoid arthritis and periodontal disease.

Mark Genovese, MD
Assistant Professor of Immunology and Rheumatology
Stanford University School of Medicine

Mark C. Genovese, MD, is an associate professor of medicine and associate chief of the division of immunology and rheumatology at Stanford University Medical Center. He received his bachelor's degree from the University of Notre Dame and his MD from the Johns Hopkins University School of Medicine. He completed an internship, residency, and chief residency in the department of medicine at Stanford University. He remained at Stanford as a postdoctoral fellow in the division of immunology and rheumatology and subsequently joined the faculty in the same division.

Dr. Genovese has established a clinical research program that is focused on bench-to-bedside translational medicine in autoimmune diseases. He has participated in a number of investigator-driven studies and in many multicenter trials. In addition, he collaborates with several other investigators on studies of biomarkers, chemokines, cytokines, and cell surface markers associated with disease progression and response to therapy. Since joining the faculty at Stanford, Dr. Genovese has served as an editor for the textbook Primary Care Rheumatology and as an associate editor for Kelley’s Essentials of Internal Medicine. He is also an editor on the 7th edition of Kelley’s Textbook of Rheumatology.

Dr. Genovese is an ad hoc reviewer for numerous medical journals, a board member of the Stanford General Clinical Research Center, and he was the recipient of a center of immunology at Stanford clinical scholars’ award.

Kathryn Hobbs, MD
Associate Clinical Professor of Internal Medicine
University of Colorado Health Sciences Center

Kathryn Hobbs, MD, is an associate clinical professor in the department of internal medicine at the University of Colorado Health Sciences Center in Denver. She is also the administrative director of clinical research at the Denver Arthritis Clinic. Previously, Dr. Hobbs served as director of clinical research for the divisions of rheumatology and allergy/clinical immunology at the University of Colorado Health Sciences Center.

After receiving her MD from Baylor College of Medicine in Houston, Dr. Hobbs completed an internship in internal medicine at Texas Medical Center, as well as a residency and fellowship at the University of Utah in Salt Lake City. At the National Jewish Center for Allergic and Respiratory Diseases in Denver, Dr. Hobbs also completed fellowships in allergy and clinical immunology and laboratory clinical immunology. Dr. Hobbs is a diplomate of the American Board of Internal Medicine with subspecialty certification in rheumatology and in allergy/immunology.

Dr. Hobbs has been the recipient of the President’s Grant-in-Aid Award and a First Place Clemons Von Pirquet Award and was a Judge Marvin Jones Presidential Scholar. A member of the American College of Rheumatology, she has served as a principal investigator on more than 10 research projects, with topics ranging from rheumatoid arthritis to respiratory diseases.

Dr. Hobbs has been published in such journals as Critical Care Medicine, American Journal of Respiratory and Critical Care Medicine and Asthma and Immunology. The topics of her writing include the molecular biology of cytokines in allergy and asthma and osteoarthritis diagnosis and management, among others.

Eric M. Ruderman, MD
Assistant Professor of Rheumatology
Northwestern University Feinberg School of Medicine

Doctor Eric M. Ruderman is an Assistant Professor of Rheumatology at Northwestern University Feinberg School of Medicine

Dr. Clifton O. Bingham III has received grants and research support from Abbott, Alexion, Amgen, Arthritis Foundation, Bristol Myers Squibb, Centacor, Genentech, Merck, NIH and Regeneron. He has served as a consultant for Abbott, Amgen, Aventis, Merck, McNeil, Novartis, Regeneron and Procter and Gamble.

Dr. Kathryn Hobbs has no “relevant” financial interest or relationships from a commercial interest whose products or services are discussed in or pertain to the content of this educational activity.

Dr. Mark Genovese has received grants and research support from Amgen, Centocor, Abbott, Biogen Idec, Genentech and Roche. He has served as a consultant for Amgen, Centocor, Abbott, Biogen, Genentech and Roche.

Dr. Eric M. Ruderman has received grants and research support from Amgen, Abbott, Bristol Myers Squibb, Genentech, Biogen Idec and Centocor. He has served as a consultant for Amgen, Wyeth, Abbott, Bristol Myers Squibb and Genentech. Dr. Ruderman has also received honorarium from Amgen and Abbott.

This educational program is supported through an educational grant from Genentech Inc and Biogen IDEC.

© 2006 the Johns Hopkins University School of Medicine. All rights reserved.