Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis

Clinical evidence demonstrates coadministration of tumour necrosis factor inhibitor (TNFi) agents and methotrexate (MTX) is more efficacious than administration of TNFi agents alone in patients with rheumatoid arthritis, leading to the perception that coadministration of MTX with all biologic agents or oral disease-modifying antirheumatic drugs is necessary for maximum efficacy. Real-life registry data reveal approximately one-third of patients taking biologic agents use them as monotherapy. Additionally, an analysis of healthcare claims data showed that when MTX was prescribed in conjunction with a biologic agent, as many as 58% of patients did not collect the MTX prescription. Given this discrepancy between perception and real life, we conducted a review of the peer-reviewed literature and rheumatology medical congress abstracts to determine whether data support biologic monotherapy as a treatment option for patients with rheumatoid arthritis. Our analysis suggests only for tocilizumab is there evidence that the efficacy of biologic monotherapy is comparable with combination therapy with MTX.

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Effectiveness of a second biologic after failure of a non-tumor necrosis factor inhibitor as first biologic in rheumatoid arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.201467 ◽

2021 ◽

pp. jrheum.201467

Author(s):

Katerina Chatzidionysiou ◽

Merete Lund Hetland ◽

Thomas Frisell ◽

Daniela Di Giuseppe ◽

Karin Hellgren ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Disease Activity ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Inhibitor ◽

Primary Response ◽

Low Disease Activity ◽

Factor Inhibitor ◽

Disease Modifying ◽

Necrosis Factor

Objective In Rheumatoid Arthritis (RA), evidence regarding the effectiveness of a second biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) in patients whose first ever bDMARD was a non-tumor-necrosis-factor-inhibitor (TNFi) bDMARD is limited. The objective of this study was therefore to assess the outcome of the second bDMARD (non-TNFi [rituximab, abatacept or tocilizumab, separately] and TNFi) after failure of a non-TNFi bDMARD as first bDMARD. Methods We identified RA patients from the five Nordic biologics registers started treatment with a non-TNFi as first ever bDMARD but switched to a second bDMARD. For the second bDMARD, we assessed survival-on-drug (at 6 and 12 months), and primary response (at 6 months). Results We included 620 patients starting a second bDMARD (ABA 86, RTX 40, TCZ 67 and TNFi 427) following failure of a first non-TNFI bDMARD. At 6 and 12 months after start of their second bDMARD, around 70% and 50%, respectively, remained on treatment, and at 6 months less than one third of patients were still on their second bDMARD and had reached low disease activity or remission according to DAS28. For those patients whose second bMDARD was a TNFI, the corresponding proportion was slightly higher (40%). Conclusion The survival-on-drug and primary response of a second bDMARD in RA patients switching due to failure of a non-TNFi bDMARD as first bDMARD is modest. Some patients may benefit from TNFi when used after failure of a non-TNFi as first bDMARD.

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FRI0289 Comparison of A Tumor Necrosis Factor Inhibitor, an Interleukin-6 Inhibitor, and Conventional Disease-Modifying Anti-Rheumatic Drugs on Bone Quality in Patients with Rheumatoid Arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-eular.4780 ◽

2014 ◽

Vol 73 (Suppl 2) ◽

pp. 489.2-489

Author(s):

Y. Yonemoto ◽

K. Okamura ◽

T. Kaneko ◽

T. Kobayashi ◽

C. Okura ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Bone Quality ◽

Interleukin 6 ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Inhibitor ◽

Factor Inhibitor ◽

Disease Modifying ◽

Necrosis Factor

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MANAGEMENT OF RHEUMATOID ARTHRITIS: SPECIAL CONSIDERATION FOR BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i11.27953 ◽

2018 ◽

Vol 11 (11) ◽

pp. 47 ◽

Cited By ~ 1

Author(s):

Salmi Abdul Razak ◽

Mohd Makmor-bakry ◽

Adyani Md Redzuan

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Inhibitor ◽

Special Consideration ◽

Biologic Therapies ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Factor Inhibitor ◽

Disease Modifying ◽

Necrosis Factor

Rheumatoid arthritis (RA) is a progressive chronic inflammatory disease affecting 0.5–1.0% of the adult population worldwide. Due to the damages caused by this autoimmune disease, new biologic therapies, particularly the biologic disease-modifying antirheumatic drugs (bDMARDs), are now being the treatment of choice in the management of RA. However, special precaution and prescreening before the usage of bDMARDs are needed to ensure better clinical response and avoiding risk of adverse event during treatment with the selected bDMARDs. In this review paper, we will provide overview on the incidence and pathogenesis of the disease, available pharmacological treatment and emphasizing special consideration in need on initiation of bDMARDs among RA patients. A literature review was performed by searching for relevant articles in Medline database through PubMed using medical subject headings terms and keywords: RA, bDMARDs, special consideration, tumor necrosis factor inhibitor, and non-tumor necrosis factor inhibitor. All papers reviewed were from 1999 to 2017 and were written in English. In this article, use of conventional synthetic DMARDs (csDMARDs), bDMARDs and special consideration to be taken upon initiation of biologic therapies in RA will be reviewed.

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