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[How early would we really administer biologics?]
1Internistisch-rheumatologische Schwerpunktpraxis, Kontumazgarten 4, 90429, Nürnberg, Deutschland. nuesslein-hu@humboog.de
Zeitschrift Fur Rheumatologie
|December 4, 2012
Summary
Many rheumatologists prefer earlier use of tumor necrosis factor-alpha (TNF-alpha) inhibitors and biologic combinations over traditional sequences. Clinical experience, rather than strict guidelines, drives this preference for improved rheumatoid arthritis treatment.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Context:
- Survey of German rheumatologists during the DGRh annual congress.
- Current EULAR recommendations favor initial methotrexate (MTX) monotherapy.
- German regulations require extensive justification for early biologic use.
Purpose:
- To gauge rheumatologists' preferences for initiating TNF-alpha inhibitors and biologic therapies.
- To understand the basis for these preferences, particularly concerning MTX failure.
- To identify potential shifts from current treatment guidelines.
Summary:
- A majority of surveyed rheumatologists advocate for earlier initiation of TNF-alpha inhibitors than EULAR guidelines suggest.
- Over half prefer combining MTX with biologics after MTX monotherapy failure, over using a second DMARD.
- These preferences are primarily driven by clinical experience, not solely by existing recommendations.
Impact:
- Highlights a potential gap between clinical practice and current treatment guidelines for rheumatoid arthritis.
- Suggests a need for updated guidelines that incorporate clinical experience and prognostic factors.
- May influence future therapeutic strategies, including parallel drug sequencing based on biomarkers.
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