Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Arthritis Res Ther. 2010;12(6):220. doi: 10.1186/ar3149. Epub 2010 Nov 4.
Most authorities recommend starting biological agents upon failure of at least one disease-modifying agent in patients with rheumatoid arthritis. However, owing to the absence of head-to-head studies, there is little guidance about which biological to select. Still, the practicing clinician has to decide. This review explores the application of published evidence to practice, discussing the goals of treatment, the (in) ability to predict individual responses to therapy, and the potential value of indirect comparisons. We suggest that cycling of biological agents, until remission is achieved or until the most effective agent for that individual patient is determined, deserves consideration in the current stage of knowledge.
大多数权威机构建议，对于类风湿关节炎患者，在至少一种疾病修饰药物治疗失败后开始使用生物制剂。然而，由于缺乏头对头研究，对于应该选择哪种生物制剂几乎没有指导。尽管如此，临床医生仍需做出决策。本综述探讨了已发表证据在实践中的应用，讨论了治疗目标、（无法）预测个体对治疗的反应能力，以及间接比较的潜在价值。我们认为，在当前的知识阶段，值得考虑在达到缓解或确定对该个体患者最有效的药物之前，循环使用生物制剂。
