scholarly journals The good initial response to therapy with a combination of traditional disease-modifying antirheumatic drugs is sustained over time: The eleven-year results of the Finnish rheumatoid arthritis combination therapy trial

2009 ◽  
Vol 60 (5) ◽  
pp. 1222-1231 ◽  
Author(s):  
Vappu Rantalaiho ◽  
Markku Korpela ◽  
Pekka Hannonen ◽  
Hannu Kautiainen ◽  
Salme Järvenpää ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Combination Therapy ◽  
Initial Response ◽  
Response To Therapy ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Disease Modifying ◽  
Therapy Trial ◽  
Over Time

scholarly journals Optimising Response to Advanced Therapies in Rheumatoid Arthritis – Using Prehabilitation to Improve Success?

2020 ◽  
pp. 87-95
Author(s):  
Alice Mason ◽  
Mariam Malik
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Disease Activity ◽  
Tnf Inhibitors ◽  
Response To Therapy ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Ongoing Research ◽  
Advanced Therapies ◽  
Disease Modifying

In recent years, a new concept of prehabilitation, enhancing an individual’s functional capacity ahead of a medical intervention, has begun to be explored in the fields of surgery and oncology, with positive results. This article explores applying the principle of prehabilitation to patients with rheumatoid arthritis prior to starting advanced therapies, including biologic disease-modifying antirheumatic drugs and targeted synthetic disease-modifying antirheumatic drugs. In this article, the literature is reviewed and the existing evidence is summarised, and the suggestion is that this approach could improve a patient’s chance of achieving low disease activity or remission. There are a number of opportunities for improving the likelihood of patients with rheumatoid arthritis having a good response to therapy. Research shows that smokers starting TNF inhibitors are less likely to achieve a good response compared to non-smokers. Obese patients are also less likely to achieve a good response with TNF inhibitors; female patients with obesity may be less likely to achieve a good response with tocilizumab and early real-world data suggest there may be a reduced response to JAK inhibitors. Rheumatoid arthritis patients experiencing depression are less likely to respond to TNF inhibitors. Increased physical activity is potentially beneficial for all rheumatoid arthritis patients, although the effect on response to specific drugs has been less widely explored. Prehabilitation approaches could include targeting smoking cessation, improving physical activity, providing psychological support, optimising BMI, and dietary changes. A number of studies have shown that each of these interventions can lead to significant improvements in disease activity scores, with some patients potentially benefitting from more than one intervention. The authors identify principles for delivering prehabilitation in practice and suggest that this is an exciting area for ongoing research.

scholarly journals AB0282 CLINICAL EFFECTIVENESS OF ABATACEPT MONOTHERAPY OR ABATACEPT CONCOMITANT METHOTREXATE THERAPY IN RHEUMATOID ARTHRITIS PATIENTS PREVIOUSLY TREATED WITH BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (bDMARDs)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1440.2-1440
Author(s):  
N. Márquez Pete ◽  
M. D. M. Maldonado Montoro ◽  
C. Pérez Ramírez ◽  
R. Cáliz Cáliz ◽  
A. Jiménez Morales
Keyword(s):  
Rheumatoid Arthritis ◽  
Combination Therapy ◽  
Disease Duration ◽  
Clinical Effectiveness ◽  
Methotrexate Therapy ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Eular Response ◽  
Aba Therapy ◽  
Disease Modifying

Background:Concomitant use of methotrexate (MTX) in abatacept (ABA) therapy is associated with good clinical response in patients with rheumatoid arthritis (RA) who are naïve to biological disease-modifying antirheumatic drugs (bDMARDs)1,2. However, it is unclear when abatacept is used in patients with prior bDMARDs use3.Objectives:We compared the effectiveness of abatacept monotherapy versus abatacept combined with methotrexate therapy in rheumatoid arthritis patients with prior bDMARDs use.Methods:Retrospective cohorts study. Rheumatoid arthritis patients treated with abatacept between 2009 and 2019 (n=86). Socio-demographic, clinical and pharmacological characteristics of patients were collected. We compared clinical effectiveness between ABA monotherapy patients (n=49) and abatacept concomitant methotrexate therapy patients (n=37), prior treated with bDMARDs. The effectiveness was measured according toThe European League Against Rheumatism(EULAR) response withDisease Activity Score(DAS28) like satisfactory (DAS28<3.2) or unsatisfactory (DAS28≥3.2), after 12 months of ABA therapy in RA patients.Results:49 RA patients have been evaluated in ABA monotherapy group; 83.67% (41/49) were women, disease duration was 16 (10-22) years and age of RA diagnosis was 48 (38.25-57.00). Concomitants glucocorticoids were administrated in 81.63% (40/49). Rheumatoid factor (RF) was positive in 75.51% (37/49) patients and cyclic citrullinated peptide antibodies (ACPA) in 71.43% (35/49). At 12 months, 40.82% (20/49) of patients had satisfactory EULAR response.In the combination therapy group, the age of RA diagnosis was 42.5 (35.75-53.50), 75.68% (28/37) were women and the disease duration was 12 (7-21) years. 89.19% (33/37) had concomitants glucocorticoids and the RF was positive in 72.97% (27/37) of patients. EULAR response was satisfactory at 12 months in 43.24% (16/37) of patients. No difference in treatment effectiveness was found in patients receiving abatacept in combination therapy with MTX compared with ABA monotherapy (p=0.829; IC95=0.35-2.35).Conclusion:Abatacept plus methotrexate therapy did not improve the effectiveness in rheumatoid arthritis patients with prior bDMARDs use, compared with abatacept monotherapy.References:[1]Genovese M, Schiff M, Luggen M, Becker J, Aranda R, Teng J, et al. Efficacy and safety of the selective co-stimulation modulator abatacept following 2 years of treatment in patients with rheumatoid arthritis and an inadequate response to anti-tumour necrosis factor therapy. Annals of the rheumatic diseases. 2008;67(4):547-54.[2]Smolen JS, Landewe RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020.[3]Walker UA, Jaeger VK, Chatzidionysiou K, Hetland ML, Hauge E-M, Pavelka K, et al. Rituximab done: what’s next in rheumatoid arthritis? A European observational longitudinal study assessing the effectiveness of biologics after rituximab treatment in rheumatoid arthritis. Rheumatology. 2016;55(2):230-6Disclosure of Interests:None declared

scholarly journals Long-term Glucocorticoid Use in Rheumatoid Arthritis

2020 ◽  
pp. jrheum.201137
Author(s):  
Maarten Boers ◽  
Theodore Pincus
Keyword(s):  
Rheumatoid Arthritis ◽  
Older Patients ◽  
Biologic Agents ◽  
Treat To Target ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
The Mean ◽  
Disease Modifying ◽  
Over Time

We read with interest the article by Hanly and Lethbridge concerning long-term patterns of glucocorticoid (GC) use in older patients with rheumatoid arthritis (RA)1. Their report indicates that GC use has remained relatively stable over time, in contrast to greater use of disease-modifying antirheumatic drugs and biologic agents in the treat-to-target directive. They also report that rheumatologists prescribe lower doses than other physicians, and that the mean dose for rheumatologists has decreased over time.

scholarly journals Comparative effectiveness of tocilizumab versus TNF inhibitors as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis after the use of at least one biologic disease-modifying antirheumatic drug: analyses from the pan-European TOCERRA register collaboration

2018 ◽  
Vol 77 (9) ◽  
pp. 1276-1282 ◽  
Author(s):  
Kim Lauper ◽  
Dan C Nordström ◽  
Karel Pavelka ◽  
Maria Victoria Hernández ◽  
Tore K Kvien ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Combination Therapy ◽  
Disease Activity ◽  
Activity Index ◽  
Tnf Inhibitors ◽  
Inadequate Response ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Drug Retention ◽  
Disease Modifying

ObjectiveTo compare the effectiveness of tocilizumab (TCZ) and tumour necrosis factor (TNF) inhibitors (TNFi) as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) after the use of at least one biologic DMARD (bDMARD).MethodsWe included patients with RA having used at least one bDMARD from 10 European registries. We compared drug retention using Kaplan-Meier and Cox models and Clinical Disease Activity Index (CDAI) change over time with mixed-effects models for longitudinal data. The proportions of CDAI remission and low disease activity (LDA) at 1 year were compared using LUNDEX correction.Results771 patients on TCZ as monotherapy (TCZ mono), 1773 in combination therapy (TCZ combo), 1404 on TNFi as monotherapy (TNFi mono) and 4660 in combination therapy (TNFi combo) were retrieved. Crude median retention was higher for TCZ mono (2.31 years, 95% CI 2.07 to 2.61) and TCZ combo (1.98 years, 95% CI 1.83 to 2.11) than TNFi combo (1.37 years, 95% CI 1.30 to 1.45) and TNFi mono (1.31 years, 95% CI 1.18 to 1.47). In a country and year of treatment initiation-stratified, covariate-adjusted analysis, hazards of discontinuation were significantly lower among patients on TCZ mono or combo compared with patients on TNFi mono or combo, and TNFi combo compared with TNFi mono, but similar between TCZ mono and combo. Average adjusted CDAI change was similar between groups. CDAI remission and LDA rates were comparable between groups.ConclusionWith significantly longer drug retention and similar efficacy to TNFi combo, TCZ mono or combo are reasonable therapeutic options in patients with inadequate response to at least one bDMARD.

scholarly journals Utilization Patterns of Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Rationale for Improving the Harmonization of Coverage Criteria

2021 ◽  
Vol 1 (8) ◽  
Author(s):  
Mina Tadrous ◽  
Mirhad Lončar ◽  
Peter Dyrda
Keyword(s):  
Rheumatoid Arthritis ◽  
British Columbia ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Coverage Criteria ◽  
Utilization Patterns ◽  
The Mean ◽  
Disease Modifying ◽  
Mean Time ◽  
Over Time

Utilization patterns of csDMARDs were highly comparable between drug plans overall (in decreasing order: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, and azathioprine). The proportion of csDMARDs were comparable (e.g., approximately 30% of csDMARD use for methotrexate), although differences in coverage criteria may have resulted in variances in the use of leflunomide. Differences in adjudication of coverage criteria may have resulted in a modest variance in the number of csDMARDs used prior to initiating bDMARDs (i.e., allowing for an “early escape” to bDMARDs for some jurisdictions such as Manitoba and the Atlantic provinces). The mean time to initiate bDMARD therapy (range of 664 to 792 days) revealed a divergence between jurisdictions into 2 groupings whereby Manitoba, Saskatchewan, and the Atlantic provinces drug plans (mean time of 664 to 681 days) saw the initiation of bDMARDs approximately 4 months faster versus other jurisdictions (British Columbia, Alberta, and Ontario, with a mean time of 748 to 792 days), possibly due to their coverage criteria not requiring 3 lines of csDMARDs therapy. Despite differences in the time to initiate bDMARDs, there was no notable difference in the persistence of bDMARDs 6 months after the initiation for any drug plan (61% to 76% range for patients 67 years of age and older). Utilization patterns of bDMARDs was highly comparable between drug plans (i.e., highest use with adalimumab, etanercept, and infliximab), although British Columbia and Manitoba were the only jurisdictions that saw decreasing costs per patient of bDMARDs over time, likely due to a higher uptake of biosimilars or other managed formulary strategies such as tiering.

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