Common clinical problems with biologics DMARDDs treatment regimens

As chronic autoimmune inflammatory diseases, ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are increasingly treated, including nonsteroidal anti-inflammatory drugs (NSAIDs), traditional synthetic anti-rheumatic drugs (DMARDs), glucocorticoids, biological DMARDs (biologics), and traditional Chinese medicine and traditional Chinese medicine preparations

What are biologics DMARDS?

Biologics DMARDDs are targeted therapeutic drugs that target immune cells or cytokines, have good specificity, and are effective drugs

Common clinical problems with biologics DMARDDs

Studies have shown that compared with the United States, the proportion of as and RA patients in China currently applying biologics is not high, and RA patients who have applied biological agents only account for about 1/5 of all patients in China [3].

1.

The cost of biologics is high both in China and abroad, and the cost of treatment accounts for about 80%

2.

65.

3.

At present, with the widespread use of biologics, the prognosis has been greatly improved

4.

Although biologics have a quick effect on the treatment of AS and RA, in the process of long-term use, they also bring adverse reactions that cannot be ignored, so biologics also bring some safety hidden dangers

Short-term adverse reactions to biologics mainly include:

1) Injection reaction

a.

b.

2) Infection

Such as lung infections, shingles infections, tuberculosis infections, etc

In summary, studies have shown that patients treated with TNF-α inhibitors have a higher risk of serious infection and tuberculosis than those treated with conventional anti-rheumatic drugs, and the risk of elevated shingles infection is not excluded from

3) Tuberculosis recurrence

Biologics can reactivate some quiescent-phase diseases (such as old or latent TB), so patients need TB testing before starting biologic therapy

According to the 2015 American Academy of Rheumatology RA treatment guidelines, patients planning to use biologics are first subjected to a PRELIMINARY SCREENING OF A PPD skin test or γ-interferon release test

solution

01 Pay attention to safety, strengthen screening and medication monitoring

The patient's overall profile should be assessed
when selecting a biologic.
Studies have shown that the risk of inflammatory infection is significantly increased in patients with low immune function or other risk of infection, so such patients must be cautious or do not use biological agents, and monitor the occurrence
of serious infections during use.

The problem of biological agents inducing tuberculosis infection is also the focus of the public, many biological agents have been reported to induce tuberculosis infection, especially infliximab, therefore, before using biological agents should do tuberculosis infection screening experiments, treatment process, patients should avoid contact with tuberculosis infection, and monitor the changes in
chest x-ray.

02 Pay attention to the efficacy, if necessary, choose the appropriate combination drug

When monobithological therapy is not up to standard or does not maintain efficacy over the long term, a combination of one or two traditional synthetic DMARDs may be considered to enhance efficacy
.
The choice of combination drug strategy is more complicated, and the following aspects need to be considered:

1.
Matching of drug mechanisms of action: drugs with different mechanisms of action are more suitable for combined use;

2.
Dose adjustment: In order to balance the efficacy and side effects, the dose of a single drug can be reduced if necessary in the joint program;

3.
Safety, especially the safety of long-term treatment, has higher requirements for the safety of another drug used in combination;

4.
Economy: When choosing a combination of drugs, it is necessary to consider the patient's medical insurance reimbursement and economic affordability;

5.
Convenience: In general, biologics will be used as drugs to quickly alleviate disease activity, and a combination of drugs suitable for long-term maintenance of the disease can be selected
.

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