Benefit and management of biologics in patients with chronic inflammatory
Prof Bernard COMBEa
a Département Rhumatologie, Hôpital Lapeyronie, Université Montpellier I -
Rheumatoid arthritis (RA) and Spondyloarthritis (SpA) control and outcome have greatly improved with the efficacy of biologic disease-modifying anti-rheumatic drugs (bDMARDs) combined with early effective management and treatment targeting remission or low disease activity. In addition, remission has now been showed to be an achieving objective in the daily management of patients with inflammatory arthritis. Overall, comparative analyses showed only minor differences with respect to efficacy and safety among the licenced bDMARDs. In RA (but not in SpA), the optimum regimen is achieved by combination of any bDMARD with synthetic DMARD such as methotrexate. Importantly, increasing evidence supports an influence of bDMARDs on prolonged survival of patients with RA, which is likely linked to a reduction of cardiovascular risk factors. A careful selection of eligible patients, a pretherapeutic screening, a tight control of disease activity and therapeutic response and a strict monitoring of possible adverse events are keys points to improve the benefit / risk ratio of these major therapeutic innovations.