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Open Access Commentary

Early start and stop of biologics: has the time come?

Ronald F van Vollenhoven1*, György Nagy23 and Paul P Tak456

Author Affiliations

1 Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), The Karolinska Institute, Stockholm 17176, Sweden

2 Department of Genetics, Cell, and Immunobiology, Faculty of Medicine, Semmelweis University, Budapest 1089, Hungary

3 Department of Rheumatology, Semmelweis University, Medical School, Budapest 1023, Hungary

4 Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands

5 University of Cambridge, Cambridge, UK

6 Current address: GlaxoSmithKline, Stevenage, UK

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BMC Medicine 2014, 12:25  doi:10.1186/1741-7015-12-25

Published: 6 February 2014

Abstract

Despite considerable advances in the management of rheumatoid arthritis, results are still not satisfactory for all patients. The treatment goal in rheumatoid arthritis is remission, and there currently are numerous conventional and biological medications available to reach this aim. There are also different treatment strategies but with only limited comparative evidence about their efficacies. More patients now achieve remission while on treatment, but it remains elusive in the majority of patients. Treatment-free remission, the ultimate goal of therapy, is only achieved in very few patients; even when this happens, it is most likely due to the natural course of the disease rather than to any specific therapies. Modern treatment is based on the initiation of aggressive therapy as soon as the diagnosis is established, and on modifying or intensifying therapy guided by frequent assessment of disease activity. In this commentary we will discuss the current treatment paradigm as well as the possibility of an induction-maintenance regimen with biological disease-modifying antirheumatic drugs in early rheumatoid arthritis.

Keywords:
Biologics; Rheumatoid arthritis; Treatment