The ‘therapeutic window’ and treating to target in rheumatoid arthritis

Hunt, Laura; Buch, Maya H

doi:10.7861/clinmedicine.13-4-387

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…That is, treating RA aggressively during early years (eg, 2 years) after diagnosis can help avoid the severe articular consequences of structural damage and disability (32,33). Whether this notion of a therapeutic window of opportunity might apply to extra-articular consequences of RA is less known (34), although the observation of the relatively early increase in CVD among patients with RA is compatible (35). Our study could not directly address this earliest period of RA disease activity because the MACE count was limited among those who were within the first 2 years of RA onset in our prevalent RA cohort.…”

Section: Discussionmentioning

confidence: 99%

Time‐Varying Association of Rheumatoid Arthritis Disease Activity to Subsequent Cardiovascular Risk

Yoshida

Harrold

Middaugh³

et al. 2022

ACR Open Rheumatology

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Objective. It is unknown how the relationship between disease activity in rheumatoid arthritis (RA) and cardiovascular (CV) events may change over time. We examined the potentially time-varying association of RA disease activity to CV events.Methods. We used the CorEvitas prevalent RA registry. The Clinical Disease Activity Index (CDAI) score category, averaged within each 6-month window since enrollment, was the exposure, and the outcome was major adverse CV events (MACEs). We used marginal structural models to estimate the hazard ratio (HR), comparing each CDAI score category with remission, allowing for differential association over time. We predicted MACE-free survival under several CDAI score scenarios.Results. We found 44,816 eligible patients (77% female; mean age 58 years) with a crude event rate of 5.3/1000 person-years (median follow-up 3.4 years). The strongest association between higher CDAI score and MACEs was observed during the first 6 months of enrollment (HR for CDAI score low 2.29 [95% CI: 1.21-4.36], moderate 2.81 [95% CI: 1.46-5.43], and high 2.99 [95% CI: 1.48-6.02]). These estimates gradually diminished; by year 5, the HRs were 1.00 (95% CI: 0.49-2.05) for low, 1.18 (95% CI: 0.51-2.71) for moderate, and 1.04 (95% CI: 0.45-2.40) for high CDAI score. Predicted MACE-free survival suggested a potential decrease in MACEs with a hypothetical earlier transition to remission.Conclusion. The association of higher disease activity with CV events may be stronger earlier in the disease course of RA. Interventional studies may be warranted to precisely determine the effect of disease activity suppression on CV events in RA.

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Section: Discussionmentioning

confidence: 99%

Time‐Varying Association of Rheumatoid Arthritis Disease Activity to Subsequent Cardiovascular Risk

Yoshida

Harrold

Middaugh³

et al. 2022

ACR Open Rheumatology

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“…Most notable is the importance of early aggressive management according to a 'treat-to-target' approach, and the introduction of biological disease-modifying antirheumatic drugs (bDMARDs). [5,6] These drugs are highly effective with regard to disease control, delaying clinical and radiological progression and joint destruction, and improving quality of life. [7] South African (SA) guidelines for the management of RA were published in 2013.…”

Section: Researchmentioning

confidence: 99%

Control of rheumatoid arthritis with conventional disease-modifying antirheumatic drugs in a tertiary hospital in central South Africa

2019

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“…Further features may include but are not limited to rheumatoid nodules, tenosynovitis, rashes, fever, and weight loss [20]. Early diagnosis within an optimal therapeutic window of between 3 and 6 months is identified to be key in achieving the most desirable and cost-effective outcome [21]. Early diagnosis and management are vital for initiating timely intervention to suppress inflammation before joint damage occurs and improve the quality of life for individuals with RA.…”

Section: Introductionmentioning

confidence: 99%

“…Treat-to-target (T2T) is a medical strategy that was established in 2010 to guide clinicians to help patients achieve the goal of clinical remission or low disease activity. It advocates early diagnosis and concomitant therapy implementation, followed by regular monitoring of disease activity and adaptation of therapy accordingly, as well as providing education and support for self-management [21,24].…”

Section: Introductionmentioning

confidence: 99%

An AI Approach to Identifying Novel Therapeutics for Rheumatoid Arthritis

Rajan,

McDonald,

Bjourson

et al. 2023

JPM

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Rheumatoid arthritis (RA) is a chronic autoimmune disorder that has a significant impact on quality of life and work capacity. Treatment of RA aims to control inflammation and alleviate pain; however, achieving remission with minimal toxicity is frequently not possible with the current suite of drugs. This review aims to summarise current treatment practices and highlight the urgent need for alternative pharmacogenomic approaches for novel drug discovery. These approaches can elucidate new relationships between drugs, genes, and diseases to identify additional effective and safe therapeutic options. This review discusses how computational approaches such as connectivity mapping offer the ability to repurpose FDA-approved drugs beyond their original treatment indication. This review also explores the concept of drug sensitisation to predict co-prescribed drugs with synergistic effects that produce enhanced anti-disease efficacy by involving multiple disease pathways. Challenges of this computational approach are discussed, including the availability of suitable high-quality datasets for comprehensive analysis and other data curation issues. The potential benefits include accelerated identification of novel drug combinations and the ability to trial and implement established treatments in a new index disease. This review underlines the huge opportunity to incorporate disease-related data and drug-related data to develop methods and algorithms that have strong potential to determine novel and effective treatment regimens.

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The ‘therapeutic window’ and treating to target in rheumatoid arthritis

Cited by 6 publications

References 27 publications

Time‐Varying Association of Rheumatoid Arthritis Disease Activity to Subsequent Cardiovascular Risk

Time‐Varying Association of Rheumatoid Arthritis Disease Activity to Subsequent Cardiovascular Risk

Control of rheumatoid arthritis with conventional disease-modifying antirheumatic drugs in a tertiary hospital in central South Africa

An AI Approach to Identifying Novel Therapeutics for Rheumatoid Arthritis

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