The American College of Rheumatology weighs in on DMARDs: using and changing, high-risk patients, vaccinations, and more.
New recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) and biologic agents in the treatment of patients with rheumatoid arthritis (RA) have been released by the American College of Rheumatology (ACR). The guidelines, an update to the ACR's 2008 recommendations, address the issues of initiating and changing drug therapies, screening for tuberculosis (TB) reactivation, immunization, and the use of biologic agents in patients at high risk for RA.
The 2012 recommendations for DMARDs and biologic agents focus on the following 4 updated sections:
• Indications for the use and changing of DMARDs and biologic therapies.
• The use of biologic agents in patients with RA at high risk for hepatitis, cancer, or congestive heart failure.
• Screening for TB in patients with RA who are starting or receiving therapy with biologic agents.
• Vaccination in patients who are starting or receiving therapy with DMARDs or biologic agents.
Although the recommendations for DMARD and biologic treatment provide a guide for rheumatologists who care for patients with RA, they should not be used to replace physician-patient discussions and clinical decisions that take into account assessments of risk and benefits, patient preferences, and economic considerations, it was noted. The authors suggested that the goal for each patient with RA should be a low disease activity level or remission but that each patient's therapy target should be specific to his or her health needs.
One change from the 2008 guidelines is a recommendation for more aggressive treatment in patients who have early RA within 6 months of the onset of symptoms. The suggested change to more intensive early therapy is based on the notions that earlier treatment may provide better outcomes; that joint damage in RA is irreversible, making prevention of damage an important goal; and that preserving physical function and health-related quality of life is necessary to reduce disability.
With many advances in RA therapies since 2008, updating recommendations that help guide rheumatologists in treating patients who have RA and are receiving DMARDs or biologic therapies is important, it was noted. The guidelines were published in Arthritis Care & Research, an ACR journal. You can also find a PDF of the updated guidelines on the ACR website.
For highlights of new features in the guidelines, listen to a brief recorded interview with the principal investigator of the update process, Dr Javinder Singh.