But Dr. Smolen suggested that more work needs to be done in this area, noting that comparative effectiveness research is something rheumatologists crave. He said that since it’s been found that a third of patients taking TNF-inhibitors don’t take them in conjunction with methotrexate or another biologic, as is generally suggested, more needs to be known about how they work as monotherapies.
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In the ADACTA study, subcutaneous tocilizumab was compared to subcutaneous adalimumab, with the results significantly favoring tocilizumab.11
The emergence of biologics has raised still another question: When can they be withdrawn, if at all. Dr. Smolen said that the research has shown that it depends on the stage of the disease. “For established RA, it may not be wise to withdraw the biologic,” he said. “Overall, withdrawal in patients will lead to flares in the vast majority of the patients. This is different in early disease.”
Thomas Collins is a freelance medical writer based in Florida.
- Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69:964-975.
- Katchamart W, Bombardier C. Systematic monitoring of disease activity using an outcome measure improves outcomes in rheumatoid arthritis. J Rheumatol. 2010;37:1411-1415.
- Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011;63:573-586.
- Saleem B, Brown AK, Quinn M, et al. Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study. Ann Rheum Dis. 2012 Jan 31. [Epub ahead of print]
- De Vera MA, Choi H, Abrahamowicz M, Kopec J, Goycochea-Robles MV, Lacaille D. Statin discontinuation and risk of acute myocardial infarction in patients with rheumatoid arthritis: A population-based cohort study. Ann Rheum Dis. 2011;70:1020-1024.
- de Jong HJ, Klungel OH, van Dijk L, et al. Use of statins is associated with an increased risk of rheumatoid arthritis. Ann Rheum Dis. 2012;71:648-654.
- Freeston JE, Wakefield RJ, Conaghan PG, Hensor EM, Stewart SP, Emery P. A diagnostic algorithm for persistence of very early inflammatory arthritis: The utility of power Doppler ultrasound when added to conventional assessment tools. Ann Rheum Dis. 2010;69:417-419.
- Nam JL, Villeneuve E, Hensor EMA, et al. Inhibition of structural damage with two intensive treatment strategies using infliximab or high dose intravenous steroid followed by treat to target in DMARD naïve rheumatoid arthritis (the IDEA study)—a preliminary report. Ann Rheum Dis. 2012;71(Suppl3):106.
- van Vollenhoven RF, Geborek P, Forslind K, et al. Conventional combination treatment versus biological treatment in methotrexate-refractory early rheumatoid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial. Lancet. 2012;379:1712-1720.
- Schiff M, Fleischmann R, Weinblatt M, et al. Abatacept SC versus adalimumab on background methotrexate in RA: One year results from the ample study. Ann Rheum Dis. 2012;71(Suppl3):60.
- Gabay C, Emery P, van Vollenhoven R, et al, Tocilizumab (TCZ) monotherapy is superior to adalimumab (ADA) monotherapy in reducing disease activity in patients with rheumatoid arthritis (RA): 24-week data from the phase 4 ADACTA trial. Ann Rheum Dis. 2012;71(Suppl3):152.