-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Yimaitong edited and arranged, please do not reprint
without authorization.
The goal of treatment for
.
The introduction of biologics to improve the condition of antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) has broadened treatment options for patients with RA1
.
According to the "Rheumatoid Arthritis Diagnosis and Treatment Standard", tumor necrosis factor α (TNFα) inhibitors are the earliest and most commonly used biological agents in the treatment of RA in China2
.
Treatment of RA follows a meeting treatment strategy, on the basis of which the European Union Against Rheumatism (EULAR) guidelines recommend changing treatment if treatment goals are not reached within 6 months of a given treatment
.
It is reported that 30%-40% of patients with RA discontinue TNF inhibitors due to poor response to TNF inhibitor therapy (lack of efficacy found after the initial dose), poor secondary response (decreased efficacy with prolonged administration), or intolerance, and treatment regimen
changes are required for all of the above.
On August 16, PeterC, a scholar at the University of Oxford, UK, and his collaborators discussed the follow-up treatment of RA patients with poor TNF inhibitor treatment based on current literature and their own clinical experience, so as to provide reference
for clinical practice.
There are two strategies for treatment adjustment
Current EULAR guidelines recommend that treatment with another bDMARDs or tsDMARDs should be considered if treatment with one bDMARDs, such as TNF inhibitors, or tsDMARDs fails1
.
The Rheumatoid Arthritis Diagnosis and Treatment Code recommends that for RA with secondary failure of TNFα inhibitor therapy, consideration may be given to switching to another TNFα inhibitor for continued treatment2
.
From clinical experience, after a poor response to the treatment of a TNF inhibitor, two basic treatment strategies will occur1:(1) switch to another TNF inhibitor; (2) Switch to drugs
with different mechanisms of action.
It may sound counterintuitive to choose another TNF inhibitor after the first TNF inhibitor has failed, but this strategy is common in the clinic, and a significant proportion of patients achieve clinical remission
after cycling TNF inhibitors.
If treatment with a second TNF inhibitor fails, EULAR guidelines recommend that patients be treated with therapeutic drugs
with different mechanisms of action.
There are nine types of factors to consider in drug selection
The choice of treatment for a specific patient with RA is influenced
by many factors.
Including lifestyle, age, comorbidities and other factors
.
The scholars summarized the influence of individual patient characteristics and TNF inhibitor treatment characteristics on the next treatment choice and gave treatment recommendations, see Figure 1
.
It was also stated that given the disabling nature of RA, rapid achievement of the set treatment goals is essential
to minimize the risk of disability for patients.
Fig.
1 Treatment decisions after TNF inhibitor treatment failure
1.
For patients with RA trying to conceive, scholars believe that the preferred order of treatment options is
There is growing evidence that antirheumatic drugs are safe
during pregnancy and lactation.
Among biologics, TNF inhibitors have been the most extensively studied and appear to be safe
for use in the first and second trimesters.
Because
before pregnancy.
Infliximab, adalimumab, etanercept, and pecelizumab are all transferred to breast milk in low proportions, and TNF inhibitors
may be considered while breastfeeding.
2.
Age
Elderly patients or patients with
to the use of
3.
Comorbidities
EULAR guidelines state that treatment decisions are based on disease activity, safety concerns, and other patient factors such as comorbidities and progression
of structural damage.
TNF inhibitors are associated with a significant reduction in the risk of
.
4.
Obesity is a risk factor
for the onset and severity of rheumatic diseases.
Based on clinical experience, the presence of obesity usually only has an impact on a small number of treatments, such as golimumab in the treatment of obese RA patients may use higher doses
.
However, a recent analysis of 10,593 patients in the German RABBIT registry showed that obesity (>30 kg/m2) had adverse effects on the efficacy of cytokine-targeted therapies (TNF inhibitors and tocilizumab), but had no effect on the efficacy of cell-targeted therapies (rituximab and abatacept), and these effects were more pronounced
in female patients compared with men.
5.
Smoking
Smoking/other use of tobacco can affect the response
to treatment in patients with RA.
Several studies have shown that smokers respond less to TNF inhibitors and are less likely to achieve treatment goals; Smoking has also been shown to reduce the efficacy of methotrexate, but has no effect
on rituximab.
6.
Lung disease
RA-related pulmonary complications are common, accounting for 10% to 20%
of total mortality.
Interstitial lung disease (ILD) is one of the pulmonary complications that may be related to
RA inflammation itself, infection, or treatment options.
Therefore, some patients may need to choose a treatment regimen
that has less impact on lung function.
Published studies have shown that TNF inhibitors have a potential role in causing or worsening ILD in patients with RA, and rituximab may improve this condition
.
Recent studies suggest that abatacept may be beneficial in
patients with RA and ILD.
7.
Pain
Pain is one of the main symptoms of RA, for which switching to a JAK inhibitor after initial TNF inhibitor therapy has failed may have an advantage over cycling TNF inhibitor, which appears to be effective
for both inflammatory and non-inflammatory pain.
Another complicating factor related to pain management in patients with RA is
.
If pain persists despite targeted treatment of systemic and local inflammation in RA, then the possibility of concomitant fibromyalgia needs to be considered and alternative health strategies
should be tried.
8.
Risk of cardiovascular disease and malignant tumors
Patients with RA are at increased risk of cardiovascular disease (CV), systemic inflammation is also thought to directly increase the risk of CV, and subclinical CV may begin early in
RA.
Therefore, treatment options for patients with RA should also consider chronic inflammation and traditional CV risk factors
.
9.
Lifestyle and patient preferences
Lifestyle has a big influence
on a patient's treatment choices.
For example, for frequent travelers and patients who do not like intravenous medications, oral and non-injectable
drugs are prescribed.
It is important to note that there is also a need to pay attention to the risk of psychological side effects associated with treatment, such as anxiety, mood changes, depression or
.
Occupation (e.
g.
, shift work) and living environment may also influence treatment choices
.
In addition, given compliance issues, older or forgetful patients are better suited to intravenous or subcutaneous medication in order to optimize treatment
.
References:
1.
Taylor PC, Matucci Cerinic M, Alten R,et al.
Managing inadequate response to initial anti-TNF therapy in rheumatoid arthritis: optimising treatment outcomes[J].
Ther Adv Musculoskelet Dis.
2022 Aug 16; 14:1759720X221114101.
doi: 10.
1177/1759720X221114101.
PMID: 35991524; PMCID: PMC9386864.
2.
Geng Yan, Xie Xi, Wang Yu, et al.
Diagnosis and treatment of rheumatoid arthritis[J].
Chinese Journal of Internal Medicine,2022,61(1):51-59.
DOI:10.
3760/cma.
j.
cn112138-20210616-00426.
