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Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD) and biological DMARDs (bDMARDs)...

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Autores principales: Tanaka, Yoshiya, Hirata, Shintaro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245498/
https://www.ncbi.nlm.nih.gov/pubmed/25389048
http://dx.doi.org/10.1007/s40265-014-0323-4
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author Tanaka, Yoshiya
Hirata, Shintaro
author_facet Tanaka, Yoshiya
Hirata, Shintaro
author_sort Tanaka, Yoshiya
collection PubMed
description Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD) and biological DMARDs (bDMARDs) has revolutionized treatment of RA and clinical remission or low disease activity (LDA) are now realistic targets, achieved by a large proportion of RA patients. We are now in a position to evaluate if it is possible to maintain remission or LDA while at the same time reducing the burden of treatment on the patient and healthcare system. Data are emerging from large, well-conducted studies designed to answer this question, shedding light on which patient populations and treatment algorithms can survive treatment discontinuation or tapering with low risk of disease flare. For early RA, approximately half of early RA patients could discontinue TNF-targeted bDMARDs without clinical flare and functional impairment after obtaining clinical remission by bDMARDs with MTX. In contrast, for established RA, fewer patients sustained remission or LDA after the discontinuation of bDMARDs and “deep remission” at the discontinuation was a key factor to maintain the treatment holiday of bDMARDs. Thus, this article provides a brief outline on withdrawing or tapering bDMARDs once patients have achieved remission or LDA in RA.
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spelling pubmed-42454982014-12-03 Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis Tanaka, Yoshiya Hirata, Shintaro Drugs Leading Article Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD) and biological DMARDs (bDMARDs) has revolutionized treatment of RA and clinical remission or low disease activity (LDA) are now realistic targets, achieved by a large proportion of RA patients. We are now in a position to evaluate if it is possible to maintain remission or LDA while at the same time reducing the burden of treatment on the patient and healthcare system. Data are emerging from large, well-conducted studies designed to answer this question, shedding light on which patient populations and treatment algorithms can survive treatment discontinuation or tapering with low risk of disease flare. For early RA, approximately half of early RA patients could discontinue TNF-targeted bDMARDs without clinical flare and functional impairment after obtaining clinical remission by bDMARDs with MTX. In contrast, for established RA, fewer patients sustained remission or LDA after the discontinuation of bDMARDs and “deep remission” at the discontinuation was a key factor to maintain the treatment holiday of bDMARDs. Thus, this article provides a brief outline on withdrawing or tapering bDMARDs once patients have achieved remission or LDA in RA. Springer International Publishing 2014-11-12 2014 /pmc/articles/PMC4245498/ /pubmed/25389048 http://dx.doi.org/10.1007/s40265-014-0323-4 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Leading Article
Tanaka, Yoshiya
Hirata, Shintaro
Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_full Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_fullStr Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_full_unstemmed Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_short Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_sort intensive intervention can lead to a treatment holiday from biological dmards in patients with rheumatoid arthritis
topic Leading Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245498/
https://www.ncbi.nlm.nih.gov/pubmed/25389048
http://dx.doi.org/10.1007/s40265-014-0323-4
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