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Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis
  1. Paul Emery1,2,
  2. Anthony Sebba3,
  3. Tom W J Huizinga4
  1. 1Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
  2. 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust United Kingdom, Leeds, UK
  3. 3Department of Rheumatology, University of South Florida, Tampa, Florida, USA
  4. 4Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Professor Paul Emery, Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; p.emery{at}leeds.ac.uk

Abstract

Clinical evidence demonstrates coadministration of tumour necrosis factor inhibitor (TNFi) agents and methotrexate (MTX) is more efficacious than administration of TNFi agents alone in patients with rheumatoid arthritis, leading to the perception that coadministration of MTX with all biologic agents or oral disease-modifying antirheumatic drugs is necessary for maximum efficacy. Real-life registry data reveal approximately one-third of patients taking biologic agents use them as monotherapy. Additionally, an analysis of healthcare claims data showed that when MTX was prescribed in conjunction with a biologic agent, as many as 58% of patients did not collect the MTX prescription. Given this discrepancy between perception and real life, we conducted a review of the peer-reviewed literature and rheumatology medical congress abstracts to determine whether data support biologic monotherapy as a treatment option for patients with rheumatoid arthritis. Our analysis suggests only for tocilizumab is there evidence that the efficacy of biologic monotherapy is comparable with combination therapy with MTX.

  • Rheumatoid Arthritis
  • Treatment
  • DMARDs (biologic)

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