How to use biologic agents in patients with rheumatoid arthritis who have comorbid disease

Abstract

Although biologic disease modifying anti-rheumatic drugs (bDMARDs) have improved the quality of life of patients with rheumatoid arthritis, side effects remain a problem, especially for patients with pre-existing comorbidities. Randomized controlled trials of such drugs in rheumatoid arthritis typically exclude patients with comorbidities and are of short duration, so they do not provide data on adverse events in these people. Other data sources such as national bDMARD registries are limited by the preselection of patients for both conventional synthetic chemical compound disease modifying anti-rheumatic drugs (csDMARDs) and bDMARDs, and although these databases document comorbidity, they rarely report its severity. This too limits definitive statements on the progression or resolution of pre-existing disease. Although bDMARDs may not be contraindicated in patients with rheumatoid arthritis and certain comorbid diseases, additional assessments or precautions are recommended. This review summarizes current data on the use of bDMARDs in people with rheumatoid arthritis and common comorbid diseases. It provides an evidence base for doctors and their patients when discussing and selecting the appropriate bDMARDs.

Elicitation of Rheumatologist Preferences for the Treatment of Patients with Rheumatoid Arthritis After the Failure of a First Conventional Synthetic Disease-Modifying Anti-Rheumatic Agent

“…Guidelines for RA invite physicians to include comorbidities in treatment decisions [ 2 , 18 ]. We found that an increase in the number of comorbidities resulted in a decreased preference for adding TNFi and TCZ, and an increased preference for ABA and RTX, as well as for the csDMARD-based strategies.…”

“…The three poor prognostic factors have been consistently used for guiding treatment decisions in RA, namely disease activity according to Disease Activity Score in 28 Joints (DAS28), presence of structural damage, and presence of autoantibodies [ 2 , 3 ]. The selected comorbidities were chosen as variables of interest because of their frequency in patients with RA [ 18 ]. None of the comorbidities were associated with an absolute or relative contraindication for any therapeutic option.…”

Pharmacotherapy for Rheumatoid Arthritis: Russian and International Guidelines

“…Несомненное клиническое значение имеют рекомендации, касающиеся ведения пациентов с некоторыми сопутствующими заболеваниями (инфекция вирусом гепатита В и С, сердечная недостаточность, злокачественные новообразования). Однако уровень их доказательности невысок, и многие проблемы безопасного лечения пациентов с коморбидными заболеваниями, в первую очередь с кардиоваскулярной патологией, требуют дальнейшего изучения [74,75] и будут более подробно обсуждены в сле-дующих лекциях программы последипломного обучения ревматологов.…”

Rheumatoid Arthritis in the Russian Federation According to Russian Arthritis Registry Data (Communication I)

“…По имеющимся данным, наиболее клинически значи-мыми формами коморбидности являются кардиоваскуляр-ная патология, остеопороз, ИЗЛ, инфекционные осложне-ния, злокачественные новообразования, недомогание, де-прессия, когнитивные расстройства [66]. Примечательно, что понимание важности коморбидных заболеваний как фактора, затрудняющего гармонизацию лечения пациен-тов, послужило основанием для разработки мультидисци-плинарных рекомендаций [73][74][75], касающихся ведения «полиморбидных» пациентов с РА (а также с псориазом О р и г и н а л ь н ы е и с с л е д о в а н и я…”