A biologic DMARD
that has not resulted in an adequate clinical response after 6 months of treatment should be withdrawn and another biologic DMARD
should be prescribed.
The use of tocilizumab, a humanized, monoclonal antibody against the IL-6 receptor, has demonstrated efficacy in open-label trials of SJIA, and in 2008 a trial of 56 SJIA patients with persistent disease despite DMARD
or biologic therapy was conducted in which tocilizumab was administered as monotherapy to all patients during the 6 week open-label, lead-in phase followed by randomization to placebo for patients who achieved at least an ACR Pedi 30 response for the following 12 weeks or until disease flare.
While starting a new DMARD
, clinicians should be aware of the possibility of cognitive impairment or age related decline in information processing that could affect the patient's decision making.
In the past 15 years, the emergence and subsequent widespread use of biologic DMARDs
has dramatically altered the expectations of both physicians and of patients, regarding outcomes in the treatment of rheumatoid arthritis.
In clinical trials, XELJANZ demonstrated consistent efficacy across a broad range of clinical measures and patient types, including patients who inadequately responded to non-biologic DMARDs
and anti-TNF agents, and it has a safety profile that is well-characterized to date," said Geno Germano, president and general manager, Specialty Care and Oncology, Pfizer.
Three recently conducted studies have shown that tocilizumab, the only approved IL-6R inhibitor to date, does not appear to require combination with MTX or any DMARD
in order to improve its overall efficacy.
Although the hemoglobin levels improved in both the DMARD
and anti-TNF therapy in patients with ACD, the results of the anti-TNF therapy were superior to those of the DMARD
In contrast, researchers reported that adalimumab was associated with a threefold increased risk of herpes zoster compared with nonbiologic DMARD
therapy in the prospective German RABBIT registry involving 5,040 RA patients.
Patients treated initially with the multiple DMARD
strategy were found to have less radiographic damage in small joints, even in the long term, than those treated initially with DMARD
The study from the Norfolk Arthritis Register in eastern England differed from earlier published studies on newly diagnosed arthritis patients in that it reflected community practice rather than a controlled study Physicians made the determination to place patients on a DMARD
, ostensibly because symptoms seemed severe early in the course of the disease.
Surveyed RA patients most frequently are taking a conventional disease-modifying antirheumatic drug (DMARD
) + a TNF-alpha inhibitor, and conventional DMARD
The SARIL-RA-TARGET trial enrolled 546 TNF-IR patients who were randomized to one of three treatment groups self-administered subcutaneously (SC) every other week (Q2W): sarilumab 200 milligrams (mg), sarilumab 150 mg, or placebo, in addition to DMARD