How would you approach using the new vagus nerve stimulator for patients with RA?

Vagus nerve stimulation (VNS) may be a consideration for treating those patients with RA who have disease that is either resistant to multiple DMARDs and biological therapies, or where the risk of immune suppression significantly outweighs the potential benefits of our standard approach to managing RA. Examples might include patients with active multiple sclerosis, myeloma or lymphoma.

The RESET- RA data achieved its primary endpoint of a higher percentage of patients achieving ACR-20 scores. In some patients, the efficacy persisted for over 1.5 years. This is all very interesting since the technique does not require immune suppression and has few major side effects.

However, there are a number of caveats. First, the study size, though powere...