MODERN VIEWS ON PATHOGENETIC THERAPY OF RHEUMATOID ARTHRITIS
DOI:
https://doi.org/10.14739/2310-1210.2013.6.20832Keywords:
early rheumatoid arthritis, biologic agents, disease - modifying antirheumatic therapyAbstract
Development of the early rheumatoid arthritis (eRA) may occurs at any age (most often at age of 40-50 years). It is known that usually it is accompanied by severe disability. That is why early diagnostic of eRA and then selecting the modern method of treatment of this disease become extremely important.
The main therapeutic techniques aimed at reducing the eRA symptoms: pain and stiffness, providing an anti-inflammatory effect, preserving the ability of the patient's day to day functions, prevention of destructive processes. After active analysis of patient comorbidity (cardio - vascular disease, osteoporosis, gastropathy) an aggressive, fast-acting therapy eRA through the use of combination regimens disease-modifying antirheumatic drugs (DMARDS), extensive use of "anti-cytokine therapy," or biological agents (BA) and biosimilars (BS) should be started as quick as possible.
To evaluate the effectiveness of treatment must take into account the dynamics of changes in clinical parameters and markers of inflammation, as well as monitoring data of questioning patients about pain intensity (VAS), the overall assessment of disease activity (DAS28) and the degree of physical function violation (HAQ).
A brief review on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids (GCS) in patients with eRA. Reported data on the safety profile of NSAIDs and GCS, as well as data on the risk reduction of bone mineral density and the development of various low-energy fractures of the use of proton pump inhibitors (PPIs) in treatment of patients with RA. In view of these clinical studies, NSAIDs have failed to demonstrate the structural disease-modifying effects, so this group of drugs should be used only in combination with DMARD and GCS. The article presents a comparative analysis of various representatives from a number of GCS.
The article presents the survey of research of the need of rapid and effective suppression of inflammation with DMARDs, which contributes to the modification of the clinical course of the disease. The most effective was induction of long-term response in RA by methotrexate (MTX), while there is a high adherence to treatment, long-term tolerability and low cost treatment. Safe of the DMARD treatment requires careful clinical monitoring of the side effects. One of the most frequent adverse events in patients taking DMARDs is the liver damage, which requires the measurement of albumin and serum aminotransferase levels every 4-8 weeks, and the assessment of the overall analysis of blood, determination of serum creatinine.
TNF-α antagonists are recommended for the treatment of RA-preserving activity, despite adequate therapy attempts by other basic drugs, most often - MTX. TNF-α antagonists may be used in combination with other DMARDs.
The article describes aspects of the BS for treatment of RA, which show a significant improvement in long-term results and effectiveness. Highlights the key issues debatedinitial-and post-treatment of RA.
Conclusion. The modern strategy for the treatment of RA has recently undergone a major change with the introduction of BA and BS. The main goals of RA therapy are not only the reduction of inflammatory changes of the destructive processes but also achievement of prolonged and sustained remission and, in some cases, complete recovery. While achieving the expected results should not be accompanied by an increase of the number of undesirable side effects.
References
American College of Rheumatology Ad Hoc Committee on
Clinical Guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis // Arthritis Rheum. – 1996. –Vol. 39. – P. 723–731.
American College of Rheumatology Ad Hoc Committee on
Glucocorticoid-Induced Osteoporosis. Recommendations for the prevention and treatment of glucocorticoidinduced osteoporosis: 2001 update // Arthritis Rheum. – 2001. – Vol. 44. – P. 1496–1503.
Aletaha D. 2010 Rheumatoid Arthritis Classifi cation Criteria An American College of Rheumatology / European League Against Rheumatism Collaborative Initiative / D. Aletaha, T. Neogi, A.J. Silman et al. // Arthritis and Rheumatism. –2010. – Vol. 62. – № 9. – P. 2569–2581.
Boers M. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis / M. Boers, A.C. Verhoeven, H.M. Markusse et al. // Lancet. – 1997. –Vol. 350. – P. 309–318.
Вrooks P.J. Birch-more DA. Pharmacokinetics of methotrexate
administered by intramuscular and subcutaneous injections in patients with rheumatoid arthritis / P.J. Brooks, W.J. Spruill, R.C. Parish // Arthritis Rheum. – 1990. – Vol. 33. – P. 91–94.
Cohen S.B. Rituximab for rheumatoid arthritis refractory to antitumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary effi cacy and safety at twenty-four weeks REFLEX Trial Group / S.B. Cohen, P. Emery, M. Greenwald et al. // Arthritis Rheum. – 2006. – Vol. 54 (9). – Р. 2793–2806.
Chan F.K.L. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis / F.K.L. Chan, L.C.T. Hung, BY. Suen et al. // N Engl J Med. – 2002. – Vol. 347. – P. 2104–2110.
Choi H.K. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study / H.K. Choi, M.A. Hern, J.D. Seeger, J.M. Robins, F. Wolfe // Lancet. – 2002. – Vol. 359. – P. 1173–1177.
Choi H.K. A cost effectiveness analysis of treatment options for methotrexate-naive rheumatoid arthritis / H.K. Choi, J.D. Seeger, K.M. Kuntz // J Rheumatol. – 2002. – Vol. 29. – P. 1156–1665.
Edwards J.C.W. Effi cacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis / J.C.W. Edwards, L. Szczepa´nski, J. Szechinski et al. // N Engl J Med. – 2004. – Vol. 350. – P. 2572–2581.
Edwards J.C.W. Effi cacy and safety of rituximab, a B-cell targeted chimeric monoclonal anti-body: a randomized, placebo-controlled trial in patients with rheumatoid arthritis / J.C.W. Edwards, L. Szczepanski, J. Szechinski et al. // Arthritis Rheum. – 2002. – Vol. 46. – Suppl: S197.
FitzGerald G.A. The coxibs, selective inhibitors of cyclooxygenase-2 / G.A. FitzGerald, C. Patrono // N Engl J Med. – 2001. – Vol. 345. – P. 433–442.
Furst D.E. Increasing methotrexate effect with increasing dose
in the treatment of resistant rheumatoid arthritis/ D.E. Furst,
R. Koehnke, L.F. Burmeister, J. Kohler, I. Cargill // J Rheumatol. – 1989. – Vol. 16. – P. 313–320.
Gabriel S. The epidemiology of rheumatoid arthritis / S. Gabriel // Rheum Dis Clin North Am. – 2001. – Vol. 27. – P. 269–281.
Genovese M. High dose oral methotrexate (MTX) in early RA is
needed for maximum effi cacy / M. Genovese, EC. Keystone, JRP. Tesser, BK. Finck, GT. Spencer-Green // Arthritis Rheum. – 2000. – Vol. 43. – Suppl: S382. Abstract.
Goldbach-Mansky R. Rheumatoid arthritis associated autoantibodies in patients with synovitis of recent onset / R. Goldbach-Mansky, J. Lee, A. McCoy et al. // Arthritis Res. – 2000. – Vol. 2. – P. 236–243.
Herman R.A. Pharmacokinetics of low-dose methotrexate in
rheumatoid arthritis patients / R.A. Herman, P. Veng Pedersen, J. Hoffman, R. Koehnke et al. // J Pharm Sci. – 1989. – Vol. 78. – P. 165–171.
Janssen N.M. The effects of immunosuppressive and antiinfl
ammatory medications on fertility, pregnancy, and lactation /
N.M. Janssen, M.S. Genta // Arch Intern Med. – 2000. – Vol. 160. – P. 610–619.
Kirwan J.R. Arthritis and Rheumatism Council Low Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis / J.R. Kirwan // N Engl J Med. – 1995. – Vol. 333. – Р. 142–146.
Krishnan E. Reduction in long term functional disability in rheumatoid arthritis from 1977 to 1998: a longitudinal study of 3035 patients / E. Krishnan, J.F. Fries // Am J Med. – 2003. – Vol. 115. – Р. 371–376.
Lipsky P.E. Infliximab and methotrexate in the treatment of rheumatoid arthritis / P.E. Lipsky, D.M.F.M. van der Heijde, E.W. St Clair et al. // N Engl J Med. – 2000. – 343. – P. 1594–1602.
Maini R. Therapeutic effi cacy of multiple intravenous infusions of anti-tumor necrosis factor a monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis / R. Maini, F. Breedveld, J. Kalden et al. // Arthr. Rheum. – 1998. – Vol. 41. – P. 1552–1563.
Marmor M.F. Recommendations on screening for chloroquine
and hydroxychloroquine retinopathy: a report by the American
Academy of Ophthalmology / M.F. Marmor, R.E. Carr, M. Easterbrook, A.A. Farjo, W.F. Mieler // Ophthalmology. – 2002. – Vol. 109. – P. 1377–1382
McDougall R. Outcome in patients with rheumatoid arthritis receiving prednisone compared to matched controls / R. McDougall, J. Sibley, M. Haga, A. Russell // J Rheumatol. – 1994. – Vol. 21. – P. 1207–1213.
Mclinnes IB. Rheumatoid arthritis: from bench to bedside /
IB. Mclinnes // Rheum Dis Clin North Am. – 2001. – Vol. 27. – P. 373–387.
Mikuls T.R. The changing face of rheumatoid arthritis therapy:
results of serial surveys / T.R. Mikuls, J. O’Dell // Arthritis Rheum. – 2000. – Vol. 43. – P. 464–465.
Moreland L.W. Glucocorticoids and rheumatoid arthritis: back
to the future? / L.W. Moreland, J.R. O’Dell // Arthritis Rheum. –
– Vol. 46. – P. 2553–2563.
Morgan S.L. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis: a double-blind, placebo-controlled trial / S.L. Morgan, J.E. Baggott, W.H. Vaughn et al. // Ann Intern Med. – 1994. – Vol. 121. – P. 833–841.
O’Dell J.R. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications / J.R. O’Dell, C.E. Haire, N. Erikson et al. // N Engl J Med. – 1996. – Vol. 334. – P. 1287–1291.
O’Dell J.R. Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: results of a two-year, randomized, double-blind, placebo-controlled trial / J.R. O’Dell,
Leff, G. Paulsen et al. // Arthritis Rheum. – 2002. – Vol. 46.
– P. 1164–1170.
O’Dell J.R. Treating rheumatoid arthritis early: a window of
opportunity / J.R. O’Dell // Arthritis Rheum. – 2002. – Vol. 46.
– P. 283–285.
Olsen N.J. New drugs for rheumatoid arthritis / N.J. Olsen,
C.M. Stein // N Engl J Med. – 2004. –Vol. 350. – P. 2167–2179.
Ortendahl M. The methotrexate therapeutic response in rheumatoid arthritis / M. Ortendahl, T. Holmes, JD. Schettler, JF. Fries // J Rheumatol. – 2002. – Vol. 29. –P. 2084–2091.
Pincus T. Long-term drug therapy for rheumatoid arthritis in
seven rheumatology private practices. II. Second line drugs and prednisone / T. Pincus, S.B. Marcum, L.F. Callahan // J Rheumatol. – 1992. – Vol. 19. – P. 1885–1894.
Quinn M.A. The therapeutic approach of early intervention
for rheumatoid arthritis: what is the evidence? / M.A. Quinn,
P.G. Conaghan, P. Emery // Rheumatology (Oxford). – 2001. – Vol. 40. – P. 1211–1220.
Rau R. Comparison of intramuscular methotrexate and gold
sodium thiomalate in the treatment of early erosive rheumatoid arthritis: 12 month data of a double-blind parallel study of 174 patients / R. Rau, G. Herborn, H. Menninger, J. Blechschmidt // Br J Rheumatol. – 1997. – Vol. 36. – P. 345–352.
Saag K.G. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events / K.G. Saag, R. Koehnke, J.R. Caldwell et al. // Am J Med. – 1994. – Vol. 96. – P. 115–123.
Saag KG. Low-dose corticosteroids in rheumatoid arthritis: a
meta-analysis of their moderate term effectiveness / K.G. Saag, L. Criswell, K.M. Sems, M.D. Nettleman, S. Kolluri // Arthritis Rheum. – 1996. – Vol. 39. – P. 1818–1825.
Silverstein F. E. Gastrointestinal toxicity with celecoxib vs non
steroidal anti-infl ammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial / F.E. Silverstein, G. Faich, J.L. Goldstein et al. // JAMA. – 2000. – Vol. 284. – P. 1247–1255.
Smolen J.S. Effi cacy and safety of lefl unomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a doubleblind, randomised, multicentre trial / J.S. Smolen, J.R. Kalden, D.L. Scott et al // Lancet. – 1999. – Vol. 353. – P. 259–266.
Sokka T. Eligibility of patients in routine care for major clinical
trials of anti-tumor necrosis factor alpha agents in rheumatoid
arthritis / T. Sokka, T. Pincus // Arthritis Rheum. – 2003. – Vol. 48. – P. 313–318.
Strand V. Treatment of active rheumatoid arthritis with lefl unomide compared with placebo and methotrexate / V. Strand, S. Cohen, M. Schiff et al. // Arch Intern Med. – 1999. – Vol. 159. – P. 2542–5250.
Strand V. The risk of cardiovascular thrombotic events with
selective cyclooxygenase2 inhibitors / V. Strand, M. Hochberg // Arthritis Rheum. – 2002. – Vol. 47. – P. 349–355.
Tugwell P. Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis / P. Tugwell, T. Pincus // N Engl J Med. – 1995. – Vol. 333. – P. 137–141.
Van der Heijde D.M. Joint erosions and patients with early rheumatoid arthritis / D.M. van der Heijde // Br J Rheumatol. – 1995. – Vol. 34. – Suppl 2. – Р. 74–78.
Van Ede A.E. Effect of folic or folinic acid supplementation on
the toxicity and effi cacy of methotrexate in rheumatoid arthritis: a forty-eight week, multicenter, randomized, doubleblind, placebo controlled study / A.E. van Ede, R.F. Laan, M.J. Rood et al. // Arthritis Rheum. – 2001. – Vol. 44. – P. 1515–1524.
Weinblatt M.E. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate / M.E. Weinblatt, J.M. Kremer, A.D. Bankhurst et al. // N Engl J Med. – 1999. – Vol. 340. – P. 253–259.
GaIB online. Sandoz announces biosimilar rituximab [Електронний ресурс]. – Режим доступу: http://www.gabionline. net/Biosimilars/News/Sandoz-announces-biosimilar-rituximab (accessed 8 Nov 2012).
ClinicalTrials.gov. GP2013 in the Treatment of RA Patients
Refractory to or Intolerant of Standard Therapy [Електронний
ресурс]. – Режим доступу: http://www.clinicaltrials.gov/ (accessed 8 Nov 2012).
ClinicalTrials.gov. Effi cacy, Pharmacokinetics, and Safety of BI 695500 in Patients With Rheumatoid Arthritis [Електронний
ресурс]. – Режим доступу: http: //www.clinicaltrials.gov/ct2/
show/NCT01682512?term=BI (accessed 8 Nov 2012).
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