Naslov
Should anti TNF-α drugs be used like glucocorticoids or instead of them

Autori
Ćurković, Božidar ; Babić-Naglić, Đurđa ; Grazio, Simeon

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Clinical and experimental rheumatology / - , 2009, 709-709

Skup
XIII Mediterranean Congress of Rheumatology

Mjesto i datum
Cavtat, Hrvatska, 18.11.2009. - 21.11.2009

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
nema dostupnih podataka

Sažetak
Anti TNF drugs are established therapy in rheumatoid arthritis with some restrictions according national recommendations. Stopping therapy for short periods does not necessarily lead to flares. Recently, it has been demonstrated that combination therapy with methotrexate and infliximab can be tapered and discontinued to DMARD monotherapy once low disease activity is achieved, especially in early rheumatoid arthritis. This shows significant role of TNF-blocking therapy in enabling sustainable remission without need for long-term administrations, which has important implications for favourable health economics. Pooled indices of multiple measures have been developed to assess and monitor patients with rheumatoid arthritis. But uantitative measurements have been applied primarily to clinical trials or research. Although translation of clinical impression into quantitative data contributes to improvement in treatment the most standard clinical care continues to be conducted according to quantitative impression and laboratory tests. To elucidate and define an appealing hypothesis whether ant TNF drugs can be used like glucocorticoides or instead of them ad hoc panel of three top experts in rheumatology in Croatia was established in order to discuss their clinical experience with anti TNF-alpha therapy. Our clinical experience based on our own patients from everyday practice acknowledge, generally accepted, fast clinical response after initial doses of TNF antagonists. But, in our view swollen joints not responding in 2 or 3 weeks remain affected and joints pattern is almost the same months later. Therefore, instead of using anti TNF therapy in fixed dose for months, even years, they might be administered in reducing dose through several months (or as maintaining therapy in lengthened intervals every 1-3 months) and even stopped and introduced again in case of disease flare, like glucocorticoids. Although little published evidence exists on the effect of withdrawal or less frequent administration of TNF-blocking therapy in patients with RA in remission, feasibility, safety and efficacy of therapy with less expensive regime in routine clinical practice using predefined rules might be an appropriate option for selectioned patients. More evidence is required to establish optimal treatment strategies and define criteria for such a selection, which we think is worth of exploring.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA