Possible reasons for the inefficacy of genetically engineered biological agents in rheumatoid arthritis and ways of its prevention
Genetically engineered biological agents (GEBAs) have held a firm place in the treatment of rheumatoid arthritis (RA). Patients are selected for this treatment in accordance with international and Russian guidelines. The question as to whether GEBAs should be added to therapy with disease-modifying...
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| Format: | Article |
| Language: | Russian |
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IMA-PRESS LLC
2012-06-01
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| Series: | Современная ревматология |
| Subjects: | |
| Online Access: | https://mrj.ima-press.net/mrj/article/view/410 |
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| Summary: | Genetically engineered biological agents (GEBAs) have held a firm place in the treatment of rheumatoid arthritis (RA). Patients are selected for this treatment in accordance with international and Russian guidelines. The question as to whether GEBAs should be added to therapy with disease-modifying anti-inflammatory drugs (DMAIDs) is raised after there is an inadequate response to therapy with two DMAIDs, one of which should be methotrexate. Tumor necrosis factor-α (TNF-α) inhibitors as a first-line drug are indicated only in high RA activity. There are few predictors of the efficacy of GEBAs. It is noted that in accordance with the principles of the Treatment to Target program, RA is treated under control of monthly estimated scores in patients with high/moderate disease activity; if there is no remission (with low disease activity being an alternative aim) after three months it is decided whether to correct therapy. In routine practice, when the effect of GEBAs, which is observed in many patients in the first week of treatment, appears, physicians often begin to discontinue symptomatic drugs and at times to decrease the dose or withdraw DMAIDs, which may result in the progression of symptoms of arthritis and which may be misinterpreted as the inadequate or none effect of GEBAs. There are objective reasons for the possible inefficacy of GEBAs. The valid predictor for a response to inhibitors of TNF-α is its baseline expression by synovial membrane cells. It is also important to take into account the nature of previous GEBA therapy. All GEBAs are noted to be highly effective when applying a weighed approach to selecting and managing patients; in so doing, rapid discontinuation of symptomatic therapy should be avoided. |
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| ISSN: | 1996-7012 2310-158X |