title: Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis.
abstract: OBJECTIVE
  A multidisciplinary expert panel, the Italian board for the TAilored BIOlogic therapy (ITABIO), was constituted to formulate evidence-based decisional statements for the first-line tailored biologic therapy in patient with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA).
  
  
  METHODS
  Systematic review of the literature to identify English-language articles on the variables influencing the first-line biologic choice, including the efficacy and safety of the drug, the route of administration, the availability of response predictor biomarkers, the need of monotherapy, the patient socio-economic status, lifestyle, cultural level, personality, fertility and childbearing potential in women, the presence of comorbidities, the host-related risk factors for infection and latent tuberculosis infection (LTBI) reactivation, the cardiovascular (CV) risk, and costs.
  
  
  RESULTS
  Some variables, including the patients' preference, the indication for anti-TNF monotherapy in potential childbearing women, and the intravenous route with dose titration in obese subjects resulted valid for all the three rheumatic conditions. Further, evidence of a better cost-effectiveness profile for etanercept (ETN) and biosimilar infliximab (IFX) in RA was found. Any biologic may be employed in absence of choice driving factors in RA. Otherwise, a high infection risk or LTBI positivity drive the choice toward abatacept (ABA), tocilizumab (TCZ), or ETN. TCZ should be the first choice if monotherapy is required. High rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) titers should drive the choice toward TCZ or ABA, while in patients at high CVD risk anti-TNF choice, with preference for ETN, seems appropriate. Presence of anterior uveitis or inflammatory bowel disease drives the choice to monoclonal antibody anti-TNFs (MoAb anti-TNFs). In PsA, ustekinumab (UTK), and to a lesser extent ETN, represents the first choice in patients at high infection and TB risk. Anti-TNFs or UTK choice is guided by skin or articular disease severity, enthesitis, and dactylitis, whereas ETN should be preferred if metabolic syndrome or high CV risk complicate PsA.
  
  
  CONCLUSIONS
  Taking in account of multiple choice driving variables, first-line biologic therapy may be optimized in patients with RA, SpA, and PsA.
authors.affiliation: Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100, Prato, Italy. Electronic address: fbrzcantini@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cantini
authors.affiliation: Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100, Prato, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Niccoli
authors.affiliation: Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100, Prato, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Nannini
authors.affiliation: Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100, Prato, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cassarà
authors.affiliation: Division of Rheumatology, Hospital of Prato, Piazza Ospedale, 1, 59100, Prato, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Kaloudi
authors.affiliation: Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Giulio Favalli
authors.affiliation: Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Becciolini
authors.affiliation: Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Biggioggero
authors.affiliation: Rheumatology Unit, Hospital S. Giovanni di Dio, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Benucci
authors.affiliation: Rheumatology Unit, Hospital S. Giovanni di Dio, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Li Gobbi
authors.affiliation: Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Florence.
authors.forename: Valentina
authors.initials: V
authors.lastname: Grossi
authors.affiliation: Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Florence.
authors.forename: Maria
authors.initials: M
authors.lastname: Infantino
authors.affiliation: Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Florence.
authors.forename: Francesca
authors.initials: F
authors.lastname: Meacci
authors.affiliation: Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Florence.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Manfredi
authors.affiliation: Department of Biomedicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Guiducci
authors.affiliation: Department of Biomedicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bellando-Randone
authors.affiliation: Department of Biomedicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
authors.affiliation: Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Foti
authors.affiliation: Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Di Gangi
authors.affiliation: UO di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Mosca
authors.affiliation: UO di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Tani
authors.affiliation: Clinical Department, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS. Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Palmieri
authors.affiliation: Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS. Rome, Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: Goletti
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006801:Humans; D057285:Precision Medicine; D025241:Spondylarthritis / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Biologics; anti-TNF; psoriatic arthritis; rheumatoid arthritis; spondyloarthritis; tailored therapy