Review of Routine Laboratory Monitoring for Patients with Rheumatoid Arthritis Receiving Biologic or Nonbiologic DMARDs

Abstract

Safety concerns associated with many drugs indicated for the treatment of rheumatoid arthritis (RA) can be attenuated by the early identification of toxicity through routine laboratory monitoring; however, a comprehensive review of the recommended monitoring guidelines for the different available RA therapies is currently unavailable. The aim of this review is to summarize the current guidelines for laboratory monitoring in patients with RA and to provide an overview of the laboratory abnormality profiles associated with each drug indicated for RA. Recommendations for the frequency of laboratory monitoring of serum lipids, liver transaminases, serum creatinine, neutrophil counts, and platelet counts in patients with RA were compiled from a literature search for published recommendations and guidelines as well as the prescribing information for each drug. Laboratory abnormality profiles for each drug were compiled from the prescribing information for each drug and a literature search including meta-analyses and primary clinical trials data.

Neutrophil/lymphocyte and platelet/lymphocyte ratios are associated with disease activity in rheumatoid arthritis

“…In RA patients, NLR has been reported to be a good indicator of response to tocilizumab treatment [23]. In a review of the treatment effect on laboratory parameters in Rigby et al in RA patients, they concluded that all treatments, including biological agents, reduced serum neutrophil and platelet levels [24]. Koiwa et al emphasized that NLR shows efficacy of biological treatments but is not a predictor of biological agent treatment [25].…”

Diagnostic Challenges and Management Update in Rheumatoid Arthritis

“…Currently, there are two JAKi approved for RA treatment, associated with MTX or as monotherapy: tofacitinib (selective for JAK1 and JAK3) and baricitinib (selective for JAK1 and JAK2). Also, other agents are undergoing clinical studies: upadacitinib and filgotinib (selective for JAK1, 74-fold selectivity for the first agent and 28-fold for the second one), peficitinib (selective for JAK1 and JAK2) and decernotinib (JAK3 selective) [124][125][126][127].…”

“…As well as baricitinib, it should be used carefully in patients with risk factors for deep vein thrombosis (DVT) or pulmonary embolism (PE) (old age, obesity, history of DVT or PE, surgery or immobilization). It is not recommended in case of pregnancy, lactation or children; it is also important to administer with caution in patients over 75 years [127]. Baricitinib, the second agent approved for the treatment of RA is a competitive ATP kinase inhibitor, selective inhibitor of JAK1 and JAK2 (100-fold selectivity over JAK3), that reduces immune cell functions by targeting several cytokines (IL-6, IL-12, IL-23, IFNs, and GM-CSF) and growth factor stimulation.…”

“…Patients monitoring is presented in Table 1. During treatment, there were reported cases of tuberculosis reactivation, herpes zoster, malignancy and thrombosis [127].…”

“…Filgotinib presents a selectivity of almost 30-fold for JAK1 versus JAK2, with dose-dependent inhibition of Th1-Th2 [124,130]. The most frequent side effects reported for JAK1 selective inhibitors are represented by nausea, cephalalgia, respiratory and urinary infections, dose-related neutropenia and an increase in serum levels for creatinine and hepatic enzymes [127].…”