Combination therapy with biologic agents in rheumatic diseases: current and future prospects

Area of Science:

• Rheumatology
• Pharmacology
• Immunology

Background:

• Rheumatoid arthritis (RA) management strategies focus on controlling disease activity and preventing damage using disease-modifying antirheumatic drugs (DMARDs).
• Treatment guidelines recommend conventional synthetic DMARDs (csDMARDs) for DMARD-naïve patients and combination therapies for those with moderate to high disease activity.
• Biological DMARDs (bDMARDs) are crucial in RA treatment, particularly in combination therapies.

Approach:

• Evaluating the efficacy of bDMARDs in combination with methotrexate (MTX) compared to monotherapy.
• Analyzing factors contributing to the superior efficacy of combination therapies, including reduced MTX toxicity and minimized anti-bDMARD antibody formation.
• Reviewing evidence supporting the use of MTX as a preferred agent in combination therapy for RA management.

Key Points:

• Combination therapy with bDMARDs and MTX demonstrates greater efficacy than monotherapy with either csDMARDs or bDMARDs.
• Concomitant use of MTX with bDMARDs improves drug retention and potentially reduces bDMARD clearance.
• MTX may mitigate bDMARD toxicity and enhance therapeutic effects, particularly with tumor necrosis factor inhibitors (TNFis).

Conclusions:

• Combination therapy involving bDMARDs, especially with MTX, is a highly effective strategy for managing RA.
• MTX is identified as the optimal companion drug for bDMARDs in RA treatment, provided no contraindications exist.
• Future RA treatment aims to optimize drug regimens for maximum efficacy and cost-effectiveness.