Conventional disease-modifying agents in rheumatoid arthritis – a review of their current use and role in treatment algorithms

Padjen, Ivan; Crnogaj, Mirna Reihl; Anić, Branimir

doi:10.5114/reum.2020.101400

Cited by 19 publications

(17 citation statements)

References 56 publications

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“…1 RA is a debilitating chronic disease and people with RA are often at a higher risk of mortality because of associated comorbidities such as cardiovascular disease. 3,4 In Canada, approximately 374,000 people aged 16 or older are currently living with diagnosed RA and approximately 1% of the global population is affected by RA. 1 The prevalence and incidence of diagnosed RA generally increases with age and females in Canada are more likely to experience diagnosed RA compared to males.…”

Section: Context and Policy Issuesmentioning

confidence: 99%

“…5 Disease-modifying antirheumatic drugs (DMARDs) are commonly used course in the treatment for RA because they slow disease progression and provide symptom relief. 4 RA treatment regimens can consist of conventional synthetic DMARDs (csDMARDs), biologic DMARDs, or targeted synthetic DMARDs (tsDMARDs). Common csDMARDs include methotrexate (MTX), leflunomide (LEF), sulfasalazine (SSZ), and antimalarials such as hydroxychloroquine (HCQ).…”

Section: Context and Policy Issuesmentioning

confidence: 99%

“…Common csDMARDs include methotrexate (MTX), leflunomide (LEF), sulfasalazine (SSZ), and antimalarials such as hydroxychloroquine (HCQ). 4 Biologic DMARDs usually include either tumour necrosis factor inhibitors or non-tumour necrosis factor inhibitors. Janus kinase (JAK) inhibitors are a commonly used tsDMARD in advanced RA treatment.…”

Section: Context and Policy Issuesmentioning

confidence: 99%

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Conventional Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis

Hill¹,

Frey²

2021

cjht

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Nine evidence-based guidelines were identified that recommend the use of conventional synthetic disease-modifying antirheumatic drugs as a first-line therapy for patients with rheumatoid arthritis prior to using biologic disease-modifying antirheumatic drugs or Janus kinase inhibitors. Methotrexate monotherapy was the most commonly recommended conventional synthetic disease-modifying antirheumatic drug recommended as first-line therapy by the included guidelines. Eight of the included guidelines recommend combination therapy using multiple conventional synthetic disease-modifying antirheumatic drugs if monotherapy is ineffective and 4 included guidelines recommend the use of glucocorticoids in combination with conventional synthetic disease-modifying antirheumatic drugs.

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Section: Context and Policy Issuesmentioning

confidence: 99%

Section: Context and Policy Issuesmentioning

confidence: 99%

Section: Context and Policy Issuesmentioning

confidence: 99%

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Conventional Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis

Hill¹,

Frey²

2021

cjht

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“…However, the anti-inflammatory effects seem to be mediated via other pathways, mainly the activation of aminoimidazole carboxamide nucleotide transformylase, leading to increased levels of adenosine. [27]. The risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients treated with corticosteroids or methotrexate is low [23].…”

Section: Occult Hbv Infection In Patients Treated With Rheumatologic Drugsmentioning

confidence: 99%

Treatment or Prophylaxis against Hepatitis B Virus Infection in Patients with Rheumatic Disease Undergoing Immunosuppressive Therapy: An Update

Stasi

Tiengo

Sadalla

et al. 2021

JCM

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Chronic hepatitis B virus (HBV) flares or reactivations are serious causes of morbidity or mortality in rheumatologic patients undergoing immunosuppressive therapy. The recent insights in the pathogenesis of rheumatic diseases led to the use of new immunosuppressive therapies indicated in case of failure, partial response, or intolerance of conventional synthetic disease-modifying anti-rheumatic drugs. Based on these premises, this review examines and discusses the main rheumatologic treatments that could require the initiation of prophylactic treatment or close monitoring of occult HBV infection in patients beginning antiviral therapy at the first signs of HBV reactivation, or antiviral treatment in chronic HBV-infected patients. We searched for relevant studies published in the last five years. Studies suggested that the presence of HBV infection is common in rheumatic patients and HBV reactivation during these immunosuppressant treatments is quite frequent in these kinds of patients. Therefore, before starting an immunosuppressive therapy, patients should be screened for HBsAg, anti-HBs, and anti-HBc and, on the basis of markers positivity, they should be carefully characterized for HBV infection phases. In conclusion, screening of HBV infection in patients undergoing immunosuppressive therapy with subsequent HBV monitoring, prophylaxis or treatment consistently reduces the risk of clinical consequences.

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“…These drugs can be used in consecutive lines of monotherapy or combination therapy, the most common initial treatment (i.e., "anchor treatment") being methotrexate as a monotherapy. 6 For patients with inadequate response to csDMARDs, the next phase of therapy is typically biologic disease-modifying antirheumatic drugs (bDMARDs) such as abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, and tocilizumab. There have been multiple large-scale randomized controlled trials that have assessed optimal treatment strategies for moderate to severe RA, such as the BeSt study.…”

Section: Background Disease and Treatmentsmentioning

confidence: 99%

Utilization Patterns of Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Rationale for Improving the Harmonization of Coverage Criteria

Tadrous¹,

Lončar²,

Dyrda³

2021

cjht

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Utilization patterns of csDMARDs were highly comparable between drug plans overall (in decreasing order: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, and azathioprine). The proportion of csDMARDs were comparable (e.g., approximately 30% of csDMARD use for methotrexate), although differences in coverage criteria may have resulted in variances in the use of leflunomide. Differences in adjudication of coverage criteria may have resulted in a modest variance in the number of csDMARDs used prior to initiating bDMARDs (i.e., allowing for an “early escape” to bDMARDs for some jurisdictions such as Manitoba and the Atlantic provinces). The mean time to initiate bDMARD therapy (range of 664 to 792 days) revealed a divergence between jurisdictions into 2 groupings whereby Manitoba, Saskatchewan, and the Atlantic provinces drug plans (mean time of 664 to 681 days) saw the initiation of bDMARDs approximately 4 months faster versus other jurisdictions (British Columbia, Alberta, and Ontario, with a mean time of 748 to 792 days), possibly due to their coverage criteria not requiring 3 lines of csDMARDs therapy. Despite differences in the time to initiate bDMARDs, there was no notable difference in the persistence of bDMARDs 6 months after the initiation for any drug plan (61% to 76% range for patients 67 years of age and older). Utilization patterns of bDMARDs was highly comparable between drug plans (i.e., highest use with adalimumab, etanercept, and infliximab), although British Columbia and Manitoba were the only jurisdictions that saw decreasing costs per patient of bDMARDs over time, likely due to a higher uptake of biosimilars or other managed formulary strategies such as tiering.

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Conventional disease-modifying agents in rheumatoid arthritis – a review of their current use and role in treatment algorithms

Cited by 19 publications

References 56 publications

Conventional Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis

Conventional Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis

Treatment or Prophylaxis against Hepatitis B Virus Infection in Patients with Rheumatic Disease Undergoing Immunosuppressive Therapy: An Update

Utilization Patterns of Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Rationale for Improving the Harmonization of Coverage Criteria

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