title: Monotherapy with biologic disease-modifying anti-rheumatic drugs in rheumatoid arthritis.
abstract: 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.
authors.affiliation: CREATE Centre, Institute of Infection & Immunity, Cardiff University, Cardiff, UK.
authors.forename: Ernest
authors.initials: E
authors.lastname: Choy
authors.affiliation: Department of Rheumatology, Medical University Vienna, Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.affiliation: CIRI/Division of Rheumatology, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Behrens
authors.affiliation: Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Finckh
authors.affiliation: Hospital Clinico, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Gomez-Reino
authors.affiliation: Department of Rheumatology, Strasbourg University Hospitals, Strasbourg, France.
authors.forename: Jacques-Eric
authors.initials: JE
authors.lastname: Gottenberg
authors.affiliation: Rheumatologic Community Practice, Erlangen.
authors.forename: Florian
authors.initials: F
authors.lastname: Schuch
authors.affiliation: Department of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubbert-Roth
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D035843:Biomedical Research / Q000639:trends; D003131:Combined Modality Therapy / Q000379:methods; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D055118:Medication Adherence; D061214:Patient Safety; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors
keywords: DMARDs; biologic therapies; immunotherapy; pharmacology; rheumatoid arthritis