Comparative evaluation of the effects of synthetic disease-modifying antirheumatic drugs and biological agents on clinical course, the rate of development of destructive changes, and quality of life in patients with rheumatoid arthritis

There are few studies of the efficiency of therapy with disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in patients with early rheumatoid arthritis (eRA) as part of a treat-to-target strategy.

Objective: to investigate the effects of DMARDs and BAs used in combination with methotrexate (MTX) on clinical course, quality of life (QoL), and the evolution of articular erosions and synovitis in patients with RA.

Patients and methods. The investigation enrolled 151 patients with eRA. At the first stage, the patients received DMARDs. At the second stage, 101 patients with persistent moderate and high disease activity were prescribed MTX at a dose of 25 mg/week or 20 mg/week in combination with infliximab (INF), or 20 mg/week in combination with rituximab (RTX). At the third stage, 20patients with persistent high disease activity were switched to tocilizumab (TCZ) therapy.

Results and discussion. At 12 months of DMARD therapy, a clinical remission was more often achieved in the MTX group. The use of INF or RTX significantly improved QoL in the patients. That of TCZ as a second- and third-line drug led to a significant decrease in DAS28-CRP.

Conclusion. There were no statistically significant differences between the INF and RTMgroups with respect to the time course of changes in CRP, ESR, circulating immune complexes, and the indicators of X-ray progression, which confirms the possibility of switching from a first-line BA to its subsequent lines with an increasing clinical disease activity. TCZ can be a second- and third-line drug when the effect of therapy with other BAs escapes.

1. Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Nasonov EL, editor. Revmatologiya. Natsional'noe rukovodstvo [Rheumatology. National guidelines]. Moscow: GEOTAR-Media; 2008. P. 290–331.

2. Nasonov EL. Pharmacotherapy of rheumatoid arthritis — a look into the 21st century. Klinicheskaya meditsina. 2005;(6):8—12. (In Russ.).

3. Nasonov EL, Karateev DE, Chichasova NV. New recommendations for the management of rheumatoid arthritis (EULAR, 2013): the role of methotrexate. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2014;52(1):8-26. (In Russ.). doi: 10.14412/1995-4484-2014-8-26

4. Nasonov EL, Karateev DE, Chichasova NV. EULAR recommendations for the treatment of rheumatoid arthritis — 2013: general characteristics and disputable problems. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013;51(6):609-23. (In Russ.). doi: 10.14412/1995-4484-2013-609-22

5. Mazurov VI, Lila AM. Rheumatoid arthritis. In: Mazurov VI, editor. Klinicheskaya revmatologiya. Rukovodstvo dlya vrachei [Clinical rheumatology. A guide for doctors]. Saint-Petersburg: Foliant; 2005. P. 87—140.

6. Belyaeva IB, Mazurov VI. Comparative evaluation of the therapeutic effect of sulfasalazine, methotrexate and Leflunomide in early rheumatoid arthritis. Vestnik Sankt-Peterburgskoi gosudarstvennoi meditsinskoi akademii im. I.I. Mechnikova. 2006;(3):129-32. (In Russ.).

7. Belyaeva IB, Mazurov VI, Trofimova TN, Trofimov EA. Rannii revmatoidnyi artrit: sovremennye vozmozhnosti diagnostiki i lecheniya [Early rheumatoid arthritis: modern diagnostic and treatment options]. Saint-Petersburg: Medforum; 2018. 138 p.

8. Avlokhova SR, Mazurov VI. The dependence of the quality of life of patients with rheumatoid arthritis on the duration of the disease. Proceedings of the XIII North-West scientific-practical conference on rheumatology. Saint-Petersburg: Chelovek i zdorov'e; 2013. P. 3.

9. Zhugrova ES, Mazurov VI, Rassokhin VV, Zav'yalkina EV. Use of infliximab (Remicade) in patients with rheumatoid arthritis. Vestnik Sankt-Peterburgskogo universiteta. 2007;11(3):50-5. (In Russ.).

10. Van Vollenhoven RF. Treatment of rheumatoid arthritis: state of the art 2009. Nat Rev Rheumatol. 2009 Oct;5(10):531-41. doi: 10.1038/nrrheum.2009.182.

11. Arnett FC, Edworthy S, Bloch DA, et al. The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315-24.

12. Oktyabr'skaya IV, Belyaeva IB. Influence of basic and biological therapy on clinical activity, quality of life and psychological status of patients with early rheumatoid arthritis. Farmateka. 2011;(9):75—7. (In Russ.)