Efficacy and safety of combination therapy for preventing bone damage in rheumatoid arthritis

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• 作者：Florenzo Iannone ; Giuseppe Lopalco ; Luca Cantarini ; Mauro Galeazzi…
• 关键词：Anti ; TNF drugs ; Methotrexate ; Rheumatoid arthritis ; Rituximab ; Tocilizumab
• 刊名：Clinical Rheumatology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：35
• 期：1
• 页码：19-23
• 全文大小：246 KB
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• 作者单位：Florenzo Iannone (1)
  Giuseppe Lopalco (1)
  Luca Cantarini (2) (3)
  Mauro Galeazzi (2)
  Giovanni Lapadula (1)
  
  1. Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
  2. Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Siena, Italy
  3. Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Rheumatology
  
• 出版者：Springer London
• ISSN：1434-9949

文摘

The main outcomes of the therapies for rheumatoid arthritis (RA) must be preventing, or at least lessening, the development of structural damage. Biological disease-modifying anti-rheumatic drugs (bDMARDs), targeting tumour necrosis factor-α (TNF-α) or other key steps (IL-1, IL-6, T cells, B cells) in the pathogenesis of RA, have given clues to be effective and safe as treatments for RA, being capable of improving disease activity, ameliorating functional ability and halting joint damage. A large body of evidence, stemming from randomized clinical trials, observational studies, and registries, has shown that the beneficial effects of the bDMARDs become optimal when combined with synthetic (s)-DMARDs, mainly methotrexate (MTX). Despite combination therapy is advocated by the international guidelines for the management of RA, data from the daily standard of care indicate that almost one third of RA patients are treated with bDMARDs as monotherapy. Many reasons may be taken into account to explain this gap from official recommendations, among which the fact that in real-life settings, the assessment of clinical outcomes is exclusively based on clinical indices, disregarding the evolution of bone damage. Furthermore, some bDMARDs have been launched in the market with the official approval to be used as monotherapy. But even for the latter, there is no conclusive proof that monotherapy regimen is comparable to co-therapy with MTX in preventing articular damage. In conclusion, the most recent published data show that combination therapy with bDMARDs and MTX represents the best therapeutic option for the treatment of RA since it can stop or at least slow the progression of disabling structural damage.