Investigators found data to support the need to tailor individual treatment strategies to improve outcomes in rheumatoid arthritis, which includes further studies to identify biomarkers and patient education about testing and expectations for treatment.
A paradigm shift in the management of rheumatoid arthritis (RA) occurred with the introduction of biologic therapy, together with the concept of a window of opportunity, advocating for an early and aggressive treat to target approach as the optimal strategy for sustained disease remission.1,2Guidelines published by the American College of Rheumatology and the European League Against Rheumatism recommend tight disease control, achieved by strict clinical monitoring, and adjusting therapy according to disease activity.3,4 With an expanding armamentarium of therapeutic options, together with the variety of diagnostic and disease monitoring tools now available, in theory, tight disease control and sustained disease remission should be achievable.
The clinical reality, however, is that this concept is challenging to execute, and the goals are difficult to achieve. A combination of patient, provider, treatment, and system factors contribute to diagnostic delays and a treat to target strategy that is complex to implement.5 Furthermore, despite the several classes of biologic and nonbiologic disease-modifying agents approved for the treatment of RA, no single agent or combination of agents can achieve sustained treatment response. For example, although tumor necrosis factor-alpha (TNF-α) inhibitors are effective treatments, many patients fail to respond. In fact, between 20% and 40% of patients treated with a TNF-α inhibitor are primary nonresponders, failing to achieve a 20% improvement in the American College of Rheumatology criteria; among responders, the response diminishes over time.6,7 Other studies have shown that prior primary nonresponders are 24% less likely to achieve remission with another biologic in the second-line setting.
|Read on: Predictive Testing for Rheumatoid Arthritis Goes Mainstream: Patient Perspectives and Considerations|