TY - JOUR
T1 - To switch or not to switch after a poor response to a TNFα blocker? It is not only a matter of ACR20 OR ACR50
AU - Buch, Mh
AU - Rubbert Roth, A
AU - Ferraccioli, Gianfranco
PY - 2012
Y1 - 2012
N2 - The introduction in the therapeutic armamentarium of TNF inhibitors (TNFi) has greatly advanced the chance of obtaining a control of clinical manifestations and of structural damage progression in an important proportion of patients with rheumatoid arthritis (RA) Methotrexate (MTX)-poor responders. However not more than 50% of TNFi treated patients can reach relevant clinical benefits. Therefore the unmet medical question is: should we continue the therapeutic approach with a second or a third TNFi, or should we use other drugs, and change the mode of action of the second drug? These are practical issues that still do not have a definite answer. The real problem is that up to this moment no real biomarker is available to make the appropriate choice. The only clear-cut biomarker is represented by the positivity of rheumatoid factor (RF) or anti citrullinated peptide autoantibodies (ACPA). Seropositive patients seem to respond better than seronegative ones to B cell depletion therapy (Rituximab). This paper discusses the pros and cons of switching or swapping in RA patients poorly responder to the first TNFi.
AB - The introduction in the therapeutic armamentarium of TNF inhibitors (TNFi) has greatly advanced the chance of obtaining a control of clinical manifestations and of structural damage progression in an important proportion of patients with rheumatoid arthritis (RA) Methotrexate (MTX)-poor responders. However not more than 50% of TNFi treated patients can reach relevant clinical benefits. Therefore the unmet medical question is: should we continue the therapeutic approach with a second or a third TNFi, or should we use other drugs, and change the mode of action of the second drug? These are practical issues that still do not have a definite answer. The real problem is that up to this moment no real biomarker is available to make the appropriate choice. The only clear-cut biomarker is represented by the positivity of rheumatoid factor (RF) or anti citrullinated peptide autoantibodies (ACPA). Seropositive patients seem to respond better than seronegative ones to B cell depletion therapy (Rituximab). This paper discusses the pros and cons of switching or swapping in RA patients poorly responder to the first TNFi.
KW - response to therapy
KW - rheumatoid arthritis
KW - response to therapy
KW - rheumatoid arthritis
UR - https://publicatt.unicatt.it/handle/10807/41201
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84861481528&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84861481528&origin=inward
U2 - 10.1016/j.autrev.2011.10.012
DO - 10.1016/j.autrev.2011.10.012
M3 - Article
SN - 1568-9972
VL - 11
SP - 558
EP - 562
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
IS - 8
ER -