Hernan Castro-Rueda1, Arthur Kavanaugh. 1. Center for Innovative Therapy, Division of Rheumatology, Allergy and Immunology, University of California, San Diego, California, USA.
Abstract
PURPOSE OF REVIEW: To describe current therapeutic trials with biologic agents for early rheumatoid arthritis, analyzing clinical and radiographic outcomes. RECENT FINDINGS: The use of tumor necrosis factor-alpha inhibitors in combination with disease-modifying antirheumatic drugs early after the diagnosis of aggressive rheumatoid arthritis seems to provide increased clinical benefit over methotrexate or tumor necrosis factor-alpha inhibitors as monotherapy, with better outcomes in terms of faster and more extensive clinical improvement. There also seems to be an increased likelihood of low-disease activity in some cases even after tapering therapy. Control of radiographic progression appears to be most effective among early rheumatoid arthritis patients treated with combination tumor necrosis factor-alpha inhibitors and methotrexate, although radiographic outcomes are better with tumor necrosis factor-alpha inhibitor monotherapy than with methotrexate alone. SUMMARY: The addition of antitumor necrosis factor-alpha agents to traditional disease-modifying antirheumatic drugs in early rheumatoid arthritis is a novel strategy which follows the principle of early and aggressive therapeutic intervention. Results from recent trials show greater levels of disease control. The impact on long-term safety and cost-efficacy are factors which will need to be better characterized over time.
PURPOSE OF REVIEW: To describe current therapeutic trials with biologic agents for early rheumatoid arthritis, analyzing clinical and radiographic outcomes. RECENT FINDINGS: The use of tumor necrosis factor-alpha inhibitors in combination with disease-modifying antirheumatic drugs early after the diagnosis of aggressive rheumatoid arthritis seems to provide increased clinical benefit over methotrexate or tumor necrosis factor-alpha inhibitors as monotherapy, with better outcomes in terms of faster and more extensive clinical improvement. There also seems to be an increased likelihood of low-disease activity in some cases even after tapering therapy. Control of radiographic progression appears to be most effective among early rheumatoid arthritispatients treated with combination tumor necrosis factor-alpha inhibitors and methotrexate, although radiographic outcomes are better with tumor necrosis factor-alpha inhibitor monotherapy than with methotrexate alone. SUMMARY: The addition of antitumor necrosis factor-alpha agents to traditional disease-modifying antirheumatic drugs in early rheumatoid arthritis is a novel strategy which follows the principle of early and aggressive therapeutic intervention. Results from recent trials show greater levels of disease control. The impact on long-term safety and cost-efficacy are factors which will need to be better characterized over time.
Authors: Anne Crilly; Helen Palmer; Mohammad B Nickdel; Lynette Dunning; John C Lockhart; Robin Plevin; Iain B McInnes; William R Ferrell Journal: Ann Rheum Dis Date: 2012-05-06 Impact factor: 19.103
Authors: Isidoro González-Álvaro; Ana M Ortiz; José María Alvaro-Gracia; Santos Castañeda; Belen Díaz-Sánchez; Inmaculada Carvajal; J Alberto García-Vadillo; Alicia Humbría; J Pedro López-Bote; Esther Patiño; Eva G Tomero; Esther F Vicente; Pedro Sabando; Rosario García-Vicuña Journal: PLoS One Date: 2011-12-29 Impact factor: 3.240