cover image: Biologic response modifier agents as first-line treatment for patients with rheumatoid arthritis

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Biologic response modifier agents as first-line treatment for patients with rheumatoid arthritis

6 Mar 2013

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects approximately 300,000 Canadians. It is characterized by pain, swelling and progressive joint damage, an increase in morbidity and mortality, and a reduction in quality of life and daily activities. Traditional disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX), leflunomide, sulfasalazine and hydroxychloroquine, have been shown to modify the clinical course of RA and to slow or stop radiographic progression. The newer biologic disease modifying agents target specific mechanisms of inflammation and have increased the therapeutic options for patients with RA. In Canada, these agents include the tumor necrosis factor (TNF) inhibitors (adalimumab, etanercept, infliximab, golimumab, and certolizumab), T cell costimulatory inhibitor (abatacept), B lymphocyte-depleting agent (rituximab), interleukin 6 antagonist (tocilizumab) and interleukin 1 inhibitor (anakinra). Based on a CADTH therapeutic review completed in 2010, biologic agents were recommended for use in adults with RA who had an inadequate response to optimal doses of DMARDs. Since that review, a number of studies have been published including trials in patients who are DMARD nav̐e. There are outstanding questions regarding the optimal use of biologic agents, as earlier and more aggressive treatment strategies are being used in clinical practice. This report will review the evidence on the clinical efficacy, cost-effectiveness and guidelines for use of biologic agents as first line therapy in adults with RA.
health science and technology research systematic reviews drugs medical research medicine health care evidence-based medicine therapy clinical trial methotrexate arthritis, rheumatoid clinical medicine rheumatology medicare rcts healthcare policy health treatment health sciences government health care rheumatoid arthritis infliximab disease-modifying antirheumatic drug dmards anakinra adalimumab etanercept dmard antirheumatic agents
Pages
48
Published in
Canada

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