Treatment Strategies for Patients With Immune-Mediated Inflammatory Diseases

Abstract

Immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA), psoriatic arthritis, axial spondyloarthritis, inflammatory diseases: a randomized clinical trial. JAMA.

Assessing Immunogenicity of Biologic Drugs in Inflammatory Joint Diseases: Progress Towards Personalized Medicine

“…The different results of the two NOR-DRUM trials may be due to different mechanisms for lack of response/primary treatment failure during the induction period and loss of response/secondary treatment failure during maintenance therapy [ 134 ]. Low drug concentrations may induce therapeutic failure during the maintenance phase, whereas high drug exposure may diminish potential benefits of TDM during the induction phase [ 135 ].…”

Half-Dose vs Stable-Dose Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Disease Flare in Patients With Rheumatoid Arthritis

“…Furthermore, RA flares were generally mild and rapidly controlled, and disease activity did not differ between groups at 12 months. The Editorial suggested these results may “guide discussions of dose reductions for patients who have adverse drug effects or who have other reasons to reduce immunomodulatory treatment.” We propose a broader interpretation: for patients willing to accept the relatively small risk of a temporary and mild arthritis flare, this study adds to a growing weight of evidence supporting strategies of csDMARD tapering in routine clinical practice.…”

“…The rate of arthritis flare in the half-dose group was greater than in the continuation group (25% vs 6%), leading the authors to conclude that their findings “do not support treatment with half-dose therapy.” However, as discussed in the accompanying Editorial, 75% of patients in the half-dose group maintained remission. Furthermore, RA flares were generally mild and rapidly controlled, and disease activity did not differ between groups at 12 months.…”

Risk factors for anti‐drug antibody formation to infliximab: Secondary analyses of a randomised controlled trial

“…The Norwegian Drug Monitoring Trial (NOR-DRUM) A randomised clinical trial assessed the effectiveness of proactive therapeutic drug monitoring (TDM) during induction of infliximab therapy and did not find TDM to be superior to standard infliximab therapy in terms of achieving clinical remission in the overall population [17]. However, the subgroup of patients who subsequently developed ADAb benefited from TDM during induction therapy, suggesting that TDM might be a beneficial treatment strategy in patients at increased risk of immunogenicity [18].…”