Tailoring biologic therapy for real-world rheumatoid arthritis patients

ABSTRACT

Introduction: The cornerstone of rheumatoid arthritis (RA) therapy relies on the treat-to-target strategy, which aims at dampening inflammation as soon as possible in order to achieve persistent low disease activity or, ideally, remission, according to validated disease activity measures. Traditional disease-modifying antirheumatic drugs (DMARDs) may be chosen in monotherapy or in combination as first-line therapy; in case of an unsatisfactory response after a 3-6-month trial, biologic therapy may be commenced.

Areas covered: Real-life RA patients may present with concomitant comorbidities/complications or be in peculiar physiological states which raise more than one question as to which biotherapy may be more well suited considering the whole clinical picture. Therefore, a thorough literature search was performed to identify the most appropriate biologic therapy in each setting considered in this review.

Expert opinion: Here we provide suggestions for the use of biologic drugs having a predictable better outcome in specific real-world conditions, so as to ideally profile the patient to the best of the current knowledge.

KEYWORDS:

• Biologic therapy
• comorbidities
• complications
• pregnancy
• rheumatoid arthritis

Article highlights

• Precision medicine is still an unmet need in rheumatoid arthritis patients.

• Biologic drugs with different characteristics may also be beneficial on associated comorbidities/complications in RA patients as well as in peculiar physiologic conditions (e.g. pregnancy).

• Tailored treatment suggestions for comorbidities/complications simultaneously occurring in RA patients or in case of peculiar physiologic conditions (e.g. pregnancy, risk of infections) are provided based on current knowledge of the specific effects of available biologic drugs.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.