Choy Ernest, Aletaha Daniel, Behrens Frank, Finckh Axel, Gomez-Reino Juan, Gottenberg Jacques-Eric, Schuch Florian, Rubbert-Roth Andrea
CREATE Centre, Institute of Infection & Immunity, Cardiff University, Cardiff, UK.
Department of Rheumatology, Medical University Vienna, Vienna, Austria.
Rheumatology (Oxford). 2017 May 1;56(5):689-697. doi: 10.1093/rheumatology/kew271.
Current EULAR guidelines state that biologic DMARD (bDMARD) therapy should be administered in combination with MTX or other conventional synthetic (cs) DMARD in RA. Nonetheless, a third of patients for whom a bDMARD agent is prescribed take it in the absence of concurrent csDMARD therapy. While the reasons underlying the low uptake of bDMARD-csDMARD combination therapy in clinical practice have not been well delineated, they may include poor adherence, contraindication to csDMARD therapy and adverse effects, as well as csDMARD withdrawal following remission. The challenges surrounding bDMARD therapy and the benefit/risk ratio of biologic monotherapy when compared with combination with a csDMARD will be discussed. We will provide insights into these important issues, as well as reviewing the evidence base differentiating biologic agents and exploring therapeutic options for patients with rheumatoid arthritis for whom csDMARD therapy is contraindicated or discontinued.
欧洲抗风湿病联盟（EULAR）现行指南指出，在类风湿关节炎（RA）的治疗中，生物性改善病情抗风湿药（bDMARD）应与甲氨蝶呤（MTX）或其他传统合成（cs）改善病情抗风湿药联合使用。尽管如此，在开具bDMARD药物处方的患者中，有三分之一在未同时接受csDMARD治疗的情况下服用该药物。虽然在临床实践中bDMARD-csDMARD联合治疗使用率低的潜在原因尚未完全明确，但可能包括依从性差、csDMARD治疗的禁忌症和不良反应，以及缓解后停用csDMARD。本文将讨论bDMARD治疗面临的挑战，以及与csDMARD联合使用相比，生物单药治疗的获益/风险比。我们将深入探讨这些重要问题，同时回顾区分生物制剂的证据基础，并探索为csDMARD治疗禁忌或已停用的类风湿关节炎患者提供的治疗选择。
