Novel treatment strategies in rheumatoid arthritis
The LancetPublished 1 June 2017
Gerd R Burmester, Janet Pope
Citations1,009
SJR quartileQ1
SJR score12.11
SNIP22.72
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TL;DR
New insights into the management of rheumatoid arthritis with targeted therapy approaches using classic and novel medications are described, and the potential effects of precision medicine in this challenging disease are outlined.
Abstract
New treatment strategies have substantially changed the course of rheumatoid arthritis. Many patients can achieve remission if the disease is recognised early and is treated promptly and continuously; however, some individuals do not respond adequately to treatment. Rapid diagnosis and a treat-to-target approach with tight monitoring and control, can increase the likelihood of remission in patients with rheumatoid arthritis. In this Series paper, we describe new insights into the management of rheumatoid arthritis with targeted therapy approaches using classic and novel medications, and outline the potential effects of precision medicine in this challenging disease. Articles are included that investigate the treat-to-target approach, which includes adding or de-escalating treatment. Rheumatoid arthritis treatment is impeded by delayed diagnosis, problematic access to specialists, and difficulties adhering to treat-to-target principles. Clinical management goals in rheumatoid arthritis include enabling rapid access to optimum diagnosis and care and the well informed use of multiple treatments approved for this disease.
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Medicine
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96 Citations2015Cem Gabay, Myriam Riek +2 more
BDMARD monotherapy is prescribed to more complex cases and is significantly less effective than bDMARD therapy in combination with sDMARDs, but to an extent that is clinically only marginally relevant.
Journal of Managed Care & Specialty PharmacyComparative Efficacy of Novel DMARDs as Monotherapy and in Combination with Methotrexate in Rheumatoid Arthritis Patients with Inadequate Response to Conventional DMARDs: A Network Meta-Analysis
96 Citations2015Felicity Buckley, Axel Finckh +3 more
Results suggest that in combination with MTX most of the available novel DMARDs have similar levels of efficacy in DMARD-IR patients, and tocilizumab displayed higher ACR responses than aTNF or tofacitinib.
Arthritis Care & ResearchTrends in Excess Mortality Among Patients With Rheumatoid Arthritis in Ontario, Canada
85 Citations2015Jessica Widdifield, Sasha Bernatsky +8 more
To evaluate excess mortality over time, comparing rheumatoid arthritis (RA) patients with the general population is compared.
Lara D. VeekenTowards prevention of autoantibody-positive rheumatoid arthritis: from lifestyle modification to preventive treatment
82 Citations2015Daniëlle M. Gerlag, Jill M. Norris +1 more
The current knowledge of factors contributing to the development of RA is focused on and the opportunities for intervention are discussed, which represents a significant paradigm shift from treatment to prevention.
Annals of the Rheumatic DiseasesA randomised controlled trial of etanercept and methotrexate to induce remission in early inflammatory arthritis: the EMPIRE trial
72 Citations2014J. Nam, Édith Villeneuve +11 more
In this group of patients with early inflammatory arthritis, almost a third had no tender, swollen joints after 1 year, and MTX+ETN was not superior to MTX monotherapy in achieving this outcome.
Annals of the Rheumatic DiseasesDoes the use of tumour necrosis factor antagonist therapy in poor prognosis, undifferentiated arthritis prevent progression to rheumatoid arthritis?
70 Citations2008Benazir Saleem, Sarah Mackie +6 more
In poor prognosis UA, a short course of TNF antagonist therapy provided modest short-term relief but did not prevent the development of RA.
Arthritis Research & TherapyImpact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritis
64 Citations2016Yvette Meißner, A. Zink +8 more
The results underline the importance of tight disease control taking not only global disease activity, but also CRP as an individual marker into account in patients with rheumatoid arthritis.
PubMedDiscontinuation of biologics in patients with rheumatoid arthritis.
61 Citations2013Yoshiya Tanaka, Shintaro Hirata +2 more
Evidence from studies suggests that MTX-naïve, early RA patients can achieve sustained biologic-free remission with no functional or radiographic progression, after treatment with combination TNF inhibitors and MTX.
Arthritis Care & ResearchTightening Up? Impact of Musculoskeletal Ultrasound Disease Activity Assessment on Early Rheumatoid Arthritis Patients Treated Using a Treat to Target Strategy
60 Citations2013James Dale, David Purves +3 more
To determine the level of agreement and potential impact on disease‐modifying antirheumatic drug (DMARD) escalation decisions and of adding musculoskeletal ultrasound (MSUS) assessment of disease activity to the Disease Activity Score in 28 joints (DAS28) in early rheumatoid arthritis (RA).
PubMedClinical relevance of switching to a second tumour necrosis factor-alpha inhibitor after discontinuation of a first tumour necrosis factor-alpha inhibitor in rheumatoid arthritis: a systematic literature review and meta-analysis.
56 Citations2011Anouck Rémy, Jérôme Avouac +2 more
This meta-analysis suggests that switching to a second TNF-alpha inhibitor is clinically relevant in RA and appears to be slightly better if the first TNF -alpha inhibitor was discontinued because of adverse events.
Annals of Internal MedicineBioequivalence of Biosimilar Tumor Necrosis Factor-α Inhibitors Compared With Their Reference Biologics
56 Citations2016Francine Chingcuanco, Jodi B Segal +2 more
A systematic review of evidence about the comparability of the pharmacokinetics, clinical efficacy, adverse events, and immunogenicity of biosimilar TNF- inhibitors and their respective reference biologics is conducted.
Annals of the Rheumatic DiseasesFive-year outcomes of probable rheumatoid arthritis treated with methotrexate or placebo during the first year (the PROMPT study)
53 Citations2013Jill van Aken, L. Heimans +7 more
After 5 years there is no lasting benefit of a 1 year initial course of MTX for patients with undifferentiated arthritis, compared with initial placebo, and the progression of radiological damage was similar in both groups.
Arthritis Research & TherapyTocilizumab as monotherapy or combination therapy for treating active rheumatoid arthritis: a meta-analysis of efficacy and safety reported in randomized controlled trials
51 Citations2016Xavier M Teitsma, Anne Karien Marijnissen +3 more
In the management of active RA, almost similar efficacy can be expected in patients unable to tolerate csDMARDs, who switch to TCZMONO compared to inadequate responders switching to add-on TCZCOMBI, and pooled effect estimates showed statistical superiority of switching to either TCZ strategy compared to continuing CSDMARD therapy.
Annals of the Rheumatic DiseasesThe Canadian Methotrexate and Etanercept Outcome Study: a randomised trial of discontinuing versus continuing methotrexate after 6 months of etanercept and methotrexate therapy in rheumatoid arthritis
51 Citations2013Janet Pope, Boulos Haraoui +4 more
Withdrawing MTX after 6 months of continuation ETN+MTX in MTX-inadequate responders with active rheumatoid arthritis did not yield the same degree of improvement between 6 and 12’months compared with continuing ETN +MTX, and non-inferiority was not achieved.
Lara D. VeekenSelf-reported comorbidity is common in early inflammatory arthritis and associated with poorer function and worse arthritis disease outcomes: results from the Canadian Early Arthritis Cohort
38 Citations2016Carol Hitchon, Gilles Boire +8 more
Comorbidity is common in early inflammatory arthritis and associated with higher disease activity, worse functional status and greater pain scores during the first year of follow-up, while the mechanisms for this association require investigation.
Arthritis Care & ResearchA randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis
38 Citations2007Helena Marzo‐Ortega, Michael J. Green +4 more
Oligoarthritis has a significant impact on function and work ability and patients treated with EI using intraarticular corticosteroids followed by sulfasalazine therapy if resistant demonstrated reduced synovitis 12 months after treatment compared with those initially treated with more conservative therapy.
Seminars in Arthritis and RheumatismElevated BMI and antibodies to citrullinated proteins interact to increase rheumatoid arthritis risk and shorten time to diagnosis: A nested case–control study of women in the Nursesʼ Health Studies
35 Citations2016Sara K. Tedeschi, Jing Cui +7 more
Elevated BMI and presence of ACPA interacted to increase rheumatoid arthritis risk, and time to RA onset was shortest among overweight/obese women with ≥2 ACPA.
Best Practice & Research Clinical RheumatologyAre early arthritis clinics necessary?
35 Citations2004Michael Quinn, P EMERY
What an EAC is, who should be referred and when, and the benefits and potential future benefits of their introduction are reviewed, as well as how they have become commonplace.
Drug SafetyBenefit and Risk of Tofacitinib in the Treatment of Rheumatoid Arthritis: A Focus on Herpes Zoster
35 Citations2016Kunihiro Yamaoka
Tofacitinib, a Janus kinase (JAK) inhibitor is an orally available, new-in-class, disease-modifying anti-rheumatic drug with similar efficacy to biologics.
ACR Open RheumatologyPersistence of Tofacitinib in the Treatment of Rheumatoid Arthritis in Open‐Label, Long‐Term Extension Studies up to 9.5 Years
31 Citations2019Janet Pope, Edward Keystone +7 more
This post hoc analysis evaluated tofacitinib persistence in patients with RA in long‐term extension (LTE) studies up to 9.5 years.
MedicinePrevalence and clinical significance of nonorgan specific antibodies in patients with autoimmune thyroiditis as predictor markers for rheumatic diseases
30 Citations2016Basant Elnady, Naglaa M. Kamal +6 more
Anti-dsDNA, RF, and anti-CCP antibodies may be used as predictive screening markers of systemic lupus erythematosus and RA, with early referral to rheumatologists for close follow-up and early diagnoses for appropriate disease management of the disease, as early disease control will allow better quality of life.
RMD OpenSystematic review and network meta-analysis of the efficacy and safety of tumour necrosis factor inhibitor–methotrexate combination therapy versus triple therapy in rheumatoid arthritis
29 Citations2017Roy Fleischmann, Vanita Tongbram +8 more
Triple therapy was associated with 65% lower odds of achieving ACR70 at 6 months compared with TNFi–methotrexate in patients with inadequate response to methotrexate and no clear differences were observed in secondary endpoints, which may help inform care of patients who fail methotreysate first-line therapy.
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