Advances in Therapy

, Volume 31, Issue 8, pp 780–802

Therapeutic Options After Treatment Failure in Rheumatoid Arthritis or Spondyloarthritides

  • Marcello Govoni
  • Alessandra Bortoluzzi
  • Andrea Lo Monaco
  • Silvano Adami
  • Olga Addimanda
  • Cristian Caimmi
  • Salvatore De Vita
  • Clodoveo Ferri
  • Andreina Manfredi
  • Giovanni Orsolini
  • Niccolò Possemato
  • Luca Quartuccio
  • Carlo Salvarani
  • Alen Zabotti
  • Maurizio Rossini
Review

DOI: 10.1007/s12325-014-0142-8

Cite this article as:
Govoni, M., Bortoluzzi, A., Lo Monaco, A. et al. Adv Ther (2014) 31: 780. doi:10.1007/s12325-014-0142-8

Abstract

The prognosis for patients with rheumatoid arthritis or spondyloarthritides has improved dramatically due to earlier diagnosis, recognition of the need to treat early with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), alone or in combinations, the establishment of treatment targets, and the development of biological DMARDs (bDMARDs). Many patients are now able to achieve clinical remission or low disease activity with therapy, and reduce or eliminate systemic corticosteroid use. Guidelines recommend methotrexate as a first-line agent for the initial treatment of rheumatoid arthritis; however, a majority of patients will require a change of csDMARD or step up to combination therapy with the addition of another csDMARD or a bDMARD. However, treatment failure is common and switching to a different therapy may be required. The large number of available treatment options, combined with a lack of comparative data, makes the choice of a new therapy complex and often not evidence based. We summarize and discuss evidence to inform treatment decisions in patients who require a change in therapy, including baseline factors that may predict response to therapy.

Keywords

Ankylosing spondylitisPsoriatic arthritisRheumatoid arthritisRheumatologySpondyloarthritidesSwitchTherapy

Supplementary material

12325_2014_142_MOESM1_ESM.pdf (191 kb)
Supplementary material 1 (PDF 190 kb)

Copyright information

© Springer Healthcare 2014

Authors and Affiliations

  • Marcello Govoni
    • 1
  • Alessandra Bortoluzzi
    • 1
  • Andrea Lo Monaco
    • 1
  • Silvano Adami
    • 2
  • Olga Addimanda
    • 3
  • Cristian Caimmi
    • 2
  • Salvatore De Vita
    • 4
  • Clodoveo Ferri
    • 5
  • Andreina Manfredi
    • 5
  • Giovanni Orsolini
    • 2
  • Niccolò Possemato
    • 3
  • Luca Quartuccio
    • 4
  • Carlo Salvarani
    • 3
  • Alen Zabotti
    • 4
  • Maurizio Rossini
    • 2
  1. 1.Department of Medical Sciences, UOC of Rheumatology, Azienda Ospedaliero-Universitaria S. Anna-FerraraUniversity of FerraraCona (FE)Italy
  2. 2.Section of Rheumatology, Department of MedicineUniversity of Verona, Policlinico Borgo RomaVeronaItaly
  3. 3.Dipartimento Medicina Interna e Specialità Mediche, S.C. ReumatologiaArcispedale Santa Maria Nuova, I.R.C.C.SReggio EmiliaItaly
  4. 4.Rheumatology Clinic, Department of Biological and Medical SciencesUniversity of UdineUdineItaly
  5. 5.Rheumatology UnitUniversity of Modena and Reggio Emilia School of MedicineModenaItaly