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Sustained biologic-free and drug-free remission in rheumatoid arthritis, where are we now?

Nagy G, van Vollenhoven RF - Arthritis Res. Ther. (2015)

Bottom Line: The advent of new medications and new treatment strategies for rheumatoid arthritis has made it possible to achieve remission in more patients than before.Although medication-free remission is only achievable in a small subset of patients, characterizing this patient cohort may provide important information about beneficial prognostic factors and the underlying mechanisms.In summary, in a subset of patients biologic-free and even drug-free remission can be achieved; pursuing these possibilities in practice may decrease the risk for long-term side effects and attenuate the economic burden of the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Semmelweis University, Faculty of Medicine, Semmelweis University, Budapest, 1023, Hungary. gyorgyngy@gmail.com.

ABSTRACT
The advent of new medications and new treatment strategies for rheumatoid arthritis has made it possible to achieve remission in more patients than before. Furthermore, recent clinical trials and register studies suggest that some patients who initially required aggressive therapy may achieve biologic-free remission or even the ultimate goal of therapy, drug-free remission, resembling recovery. Here, we present a discursive review of the most important studies addressing these issues. Based on the overall results, it remains unclear if achieving biologic-free and drug-free remissions are primarily due to the natural course of the disease or to the early therapeutic intervention according to the 'window of opportunity' hypothesis. Although medication-free remission is only achievable in a small subset of patients, characterizing this patient cohort may provide important information about beneficial prognostic factors and the underlying mechanisms. In summary, in a subset of patients biologic-free and even drug-free remission can be achieved; pursuing these possibilities in practice may decrease the risk for long-term side effects and attenuate the economic burden of the disease.

No MeSH data available.


Related in: MedlinePlus

Phases of rheumatoid arthritis - a hypothetical model. Question marks indicate hypothetical statements. CCP, cyclic citrullinated peptide; RA, rheumatoid arthritis; RF, rheumatoid factor; SE, shared epitope
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Fig1: Phases of rheumatoid arthritis - a hypothetical model. Question marks indicate hypothetical statements. CCP, cyclic citrullinated peptide; RA, rheumatoid arthritis; RF, rheumatoid factor; SE, shared epitope

Mentions: Early control of inflammation in rheumatoid arthritis (RA) generally results in better outcomes; thus, the current treatment strategy is to initiate aggressive therapy as soon as possible after diagnosis has been established, and to extend the therapy, according to the disease activity, to reach clinical remission [1] (Fig. 1). Currently we have many synthetic and biological disease modifying antirheumatic drugs (sDMARD and bDMARD, respectively) to achieve this aim. With appropriate use of biologicals and tight control strategies, remarkable improvement is achievable in clinical outcomes, and remission is possible in an increasing numbers of patients. Lifelong treatment with bDMARDs is very expensive and entails potential long-term side effects. According to the EULAR recommendations [2], if a patient is in remission, bDMARD and in the case of sustained remission even sDMARD therapy might be tapered. Here we summarize the current understanding of biologic-free and drug-free remission in RA.Fig. 1


Sustained biologic-free and drug-free remission in rheumatoid arthritis, where are we now?

Nagy G, van Vollenhoven RF - Arthritis Res. Ther. (2015)

Phases of rheumatoid arthritis - a hypothetical model. Question marks indicate hypothetical statements. CCP, cyclic citrullinated peptide; RA, rheumatoid arthritis; RF, rheumatoid factor; SE, shared epitope
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522973&req=5

Fig1: Phases of rheumatoid arthritis - a hypothetical model. Question marks indicate hypothetical statements. CCP, cyclic citrullinated peptide; RA, rheumatoid arthritis; RF, rheumatoid factor; SE, shared epitope
Mentions: Early control of inflammation in rheumatoid arthritis (RA) generally results in better outcomes; thus, the current treatment strategy is to initiate aggressive therapy as soon as possible after diagnosis has been established, and to extend the therapy, according to the disease activity, to reach clinical remission [1] (Fig. 1). Currently we have many synthetic and biological disease modifying antirheumatic drugs (sDMARD and bDMARD, respectively) to achieve this aim. With appropriate use of biologicals and tight control strategies, remarkable improvement is achievable in clinical outcomes, and remission is possible in an increasing numbers of patients. Lifelong treatment with bDMARDs is very expensive and entails potential long-term side effects. According to the EULAR recommendations [2], if a patient is in remission, bDMARD and in the case of sustained remission even sDMARD therapy might be tapered. Here we summarize the current understanding of biologic-free and drug-free remission in RA.Fig. 1

Bottom Line: The advent of new medications and new treatment strategies for rheumatoid arthritis has made it possible to achieve remission in more patients than before.Although medication-free remission is only achievable in a small subset of patients, characterizing this patient cohort may provide important information about beneficial prognostic factors and the underlying mechanisms.In summary, in a subset of patients biologic-free and even drug-free remission can be achieved; pursuing these possibilities in practice may decrease the risk for long-term side effects and attenuate the economic burden of the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Semmelweis University, Faculty of Medicine, Semmelweis University, Budapest, 1023, Hungary. gyorgyngy@gmail.com.

ABSTRACT
The advent of new medications and new treatment strategies for rheumatoid arthritis has made it possible to achieve remission in more patients than before. Furthermore, recent clinical trials and register studies suggest that some patients who initially required aggressive therapy may achieve biologic-free remission or even the ultimate goal of therapy, drug-free remission, resembling recovery. Here, we present a discursive review of the most important studies addressing these issues. Based on the overall results, it remains unclear if achieving biologic-free and drug-free remissions are primarily due to the natural course of the disease or to the early therapeutic intervention according to the 'window of opportunity' hypothesis. Although medication-free remission is only achievable in a small subset of patients, characterizing this patient cohort may provide important information about beneficial prognostic factors and the underlying mechanisms. In summary, in a subset of patients biologic-free and even drug-free remission can be achieved; pursuing these possibilities in practice may decrease the risk for long-term side effects and attenuate the economic burden of the disease.

No MeSH data available.


Related in: MedlinePlus