[How early would we really administer biologics?]

According to a survey carried out during the annual congress of the German Society for Rheumatology (DGRh) last year, many rheumatologists would like to initiate TNF-alpha inhibitors earlier than suggested in the EULAR recommendations. While most of the survey participants agreed with the initial MTX monotherapy favored therein, more than half would prefer to combine MTX with a biologic instead of a second DMARD after failure of this option. This decision seems to be based mainly on clinical experience. Although international therapy guidelines allow an earlier use of biologic therapy in special cases, particularly in Germany an extensive documentation and justification is needed for this treatment strategy. Future guidelines may allow several parallel drug sequences based on prognostic factors and individual biomarkers.