What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review

Abstract

Even when heterogeneity of patients is taken into account, prolonged symptom duration is associated with radiographic progression and a lower chance on DMARD-free sustained remission. These data may support the presence of a 'window of opportunity'.

A Decade of Data Discloses the Window Is Still Not Clear

“…Evidence supporting this window of opportunity for RA treatment has recently been reviewed, and the conclusion supported the notion of such an opportunity 11 . The timing and duration of this phase were not clearly defined.…”

“…The first 12 weeks after the onset of symptoms has previously been suggested as a possible time frame, although the definition of symptom onset has been highly variable in many previous studies. The time frame may indeed be longer, as others have suggested 11 . This has led to a proposal for clearer definitions of disease duration in clinical trials, and this published viewpoint presents a clear summary of many of the issues involved in the timing of such a window 12 .…”

“…The window of opportunity is supposed to represent an early phase of RA during which treatment is at least more, if not most, successful, presumably because the underlying immunopathologic processes are not yet fixed or immutable 8,9,10,11 . This is the interval during which the disease is theoretically most susceptible to disease-modifying medications.…”

Étude et Suivi:Rheumatoid Arthritis in the 21st Century

“…A multitude of studies have demonstrated that early intervention improves outcomes, and in particular, treatment during the so-called "window of opportunity," when patients first develop inflammatory arthritis, may halt development of chronic symptoms altogether 1,2 . We have new classification criteria 3 , developed specifically to aid early identification of patients who are likely to need disease-modifying therapy, and a host of new biologic drugs, in particular anti-tumor necrosis factor therapies, that have revolutionized our ability to suppress disease activity 4 .…”

Rheumatoid Arthritis: The Problems of Remission and Therapy Resistance

“…В целом на фоне терапии, которая проводится согласно современным стандартам, стойкая ремиссия достигается у 20-40% пациентов [2,9]. Одним из реша-ющих факторов возможности достижения стойкой ре-миссии является ранее начало терапии, что соответству-ет концепции «окна возможности» (window of opportunity) [26]. У пациентов, получающих ингибиторы фак-тора некроза опухоли α (ФНОα), сочетанное примене-ние МТ являлось предиктором «стойкой» ремиссии, в то время как исходная активность заболевания, ЧПС, возраст, пол, длительность заболевания, функциональ-ная недостаточность плохо коррелировали с последую-щим развитием ремиссии [27].…”