Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis

Fabrizio Cantini, Laura Niccoli, Carlotta Nannini, Emanuele Cassarà, Olga Kaloudi, Ennio Giulio Favalli, Andrea Becciolini, Martina Biggioggero, Maurizio Benucci, Francesca Li Gobbi, Valentina Grossi, Maria Infantino, Francesca Meacci, Mariangela Manfredi, Serena Guiducci, Silvia Bellando-Randone, Marco Matucci-Cerinic, Rosario Foti, Marcella Di Gangi, Marta MoscaChiara Tani, Fabrizio Palmieri, Delia Goletti

Research output: Contribution to journalArticle

Abstract

Objective: A multidisciplinary expert panel, the Italian board for the TAilored BIOlogic therapy (ITABIO), was constituted to formulate evidence-based decisional statements for the first-line tailored biologic therapy in patient with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA). Methods: Systematic review of the literature to identify English-language articles on the variables influencing the first-line biologic choice, including the efficacy and safety of the drug, the route of administration, the availability of response predictor biomarkers, the need of monotherapy, the patient socio-economic status, lifestyle, cultural level, personality, fertility and childbearing potential in women, the presence of comorbidities, the host-related risk factors for infection and latent tuberculosis infection (LTBI) reactivation, the cardiovascular (CV) risk, and costs. Results: Some variables, including the patients' preference, the indication for anti-TNF monotherapy in potential childbearing women, and the intravenous route with dose titration in obese subjects resulted valid for all the three rheumatic conditions. Further, evidence of a better cost-effectiveness profile for etanercept (ETN) and biosimilar infliximab (IFX) in RA was found. Any biologic may be employed in absence of choice driving factors in RA. Otherwise, a high infection risk or LTBI positivity drive the choice toward abatacept (ABA), tocilizumab (TCZ), or ETN. TCZ should be the first choice if monotherapy is required. High rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) titers should drive the choice toward TCZ or ABA, while in patients at high CVD risk anti-TNF choice, with preference for ETN, seems appropriate. Presence of anterior uveitis or inflammatory bowel disease drives the choice to monoclonal antibody anti-TNFs (MoAb anti-TNFs). In PsA, ustekinumab (UTK), and to a lesser extent ETN, represents the first choice in patients at high infection and TB risk. Anti-TNFs or UTK choice is guided by skin or articular disease severity, enthesitis, and dactylitis, whereas ETN should be preferred if metabolic syndrome or high CV risk complicate PsA. Conclusion: Taking in account of multiple choice driving variables, first-line biologic therapy may be optimized in patients with RA, SpA, and PsA.

Original languageEnglish
Pages (from-to)519-532
Number of pages14
JournalSeminars in Arthritis and Rheumatism
Volume45
Issue number5
DOIs
Publication statusPublished - Apr 1 2016

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Psoriatic Arthritis
Biological Therapy
Rheumatoid Arthritis
Latent Tuberculosis
Biosimilar Pharmaceuticals
Infection
Drug Administration Routes
Anterior Uveitis
Patient Preference
Rheumatoid Factor
Inflammatory Bowel Diseases
Cost-Benefit Analysis
Fertility
Personality
Life Style
Comorbidity
Language
Joints
Biomarkers
Monoclonal Antibodies

Keywords

  • Anti-TNF
  • Biologics
  • Psoriatic arthritis
  • Rheumatoid arthritis
  • Spondyloarthritis
  • Tailored therapy

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. / Cantini, Fabrizio; Niccoli, Laura; Nannini, Carlotta; Cassarà, Emanuele; Kaloudi, Olga; Giulio Favalli, Ennio; Becciolini, Andrea; Biggioggero, Martina; Benucci, Maurizio; Li Gobbi, Francesca; Grossi, Valentina; Infantino, Maria; Meacci, Francesca; Manfredi, Mariangela; Guiducci, Serena; Bellando-Randone, Silvia; Matucci-Cerinic, Marco; Foti, Rosario; Di Gangi, Marcella; Mosca, Marta; Tani, Chiara; Palmieri, Fabrizio; Goletti, Delia.

In: Seminars in Arthritis and Rheumatism, Vol. 45, No. 5, 01.04.2016, p. 519-532.

Research output: Contribution to journalArticle

Cantini, F, Niccoli, L, Nannini, C, Cassarà, E, Kaloudi, O, Giulio Favalli, E, Becciolini, A, Biggioggero, M, Benucci, M, Li Gobbi, F, Grossi, V, Infantino, M, Meacci, F, Manfredi, M, Guiducci, S, Bellando-Randone, S, Matucci-Cerinic, M, Foti, R, Di Gangi, M, Mosca, M, Tani, C, Palmieri, F & Goletti, D 2016, 'Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis', Seminars in Arthritis and Rheumatism, vol. 45, no. 5, pp. 519-532. https://doi.org/10.1016/j.semarthrit.2015.10.001
Cantini, Fabrizio ; Niccoli, Laura ; Nannini, Carlotta ; Cassarà, Emanuele ; Kaloudi, Olga ; Giulio Favalli, Ennio ; Becciolini, Andrea ; Biggioggero, Martina ; Benucci, Maurizio ; Li Gobbi, Francesca ; Grossi, Valentina ; Infantino, Maria ; Meacci, Francesca ; Manfredi, Mariangela ; Guiducci, Serena ; Bellando-Randone, Silvia ; Matucci-Cerinic, Marco ; Foti, Rosario ; Di Gangi, Marcella ; Mosca, Marta ; Tani, Chiara ; Palmieri, Fabrizio ; Goletti, Delia. / Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. In: Seminars in Arthritis and Rheumatism. 2016 ; Vol. 45, No. 5. pp. 519-532.
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T1 - Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis

AU - Cantini, Fabrizio

AU - Niccoli, Laura

AU - Nannini, Carlotta

AU - Cassarà, Emanuele

AU - Kaloudi, Olga

AU - Giulio Favalli, Ennio

AU - Becciolini, Andrea

AU - Biggioggero, Martina

AU - Benucci, Maurizio

AU - Li Gobbi, Francesca

AU - Grossi, Valentina

AU - Infantino, Maria

AU - Meacci, Francesca

AU - Manfredi, Mariangela

AU - Guiducci, Serena

AU - Bellando-Randone, Silvia

AU - Matucci-Cerinic, Marco

AU - Foti, Rosario

AU - Di Gangi, Marcella

AU - Mosca, Marta

AU - Tani, Chiara

AU - Palmieri, Fabrizio

AU - Goletti, Delia

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objective: A multidisciplinary expert panel, the Italian board for the TAilored BIOlogic therapy (ITABIO), was constituted to formulate evidence-based decisional statements for the first-line tailored biologic therapy in patient with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA). Methods: Systematic review of the literature to identify English-language articles on the variables influencing the first-line biologic choice, including the efficacy and safety of the drug, the route of administration, the availability of response predictor biomarkers, the need of monotherapy, the patient socio-economic status, lifestyle, cultural level, personality, fertility and childbearing potential in women, the presence of comorbidities, the host-related risk factors for infection and latent tuberculosis infection (LTBI) reactivation, the cardiovascular (CV) risk, and costs. Results: Some variables, including the patients' preference, the indication for anti-TNF monotherapy in potential childbearing women, and the intravenous route with dose titration in obese subjects resulted valid for all the three rheumatic conditions. Further, evidence of a better cost-effectiveness profile for etanercept (ETN) and biosimilar infliximab (IFX) in RA was found. Any biologic may be employed in absence of choice driving factors in RA. Otherwise, a high infection risk or LTBI positivity drive the choice toward abatacept (ABA), tocilizumab (TCZ), or ETN. TCZ should be the first choice if monotherapy is required. High rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) titers should drive the choice toward TCZ or ABA, while in patients at high CVD risk anti-TNF choice, with preference for ETN, seems appropriate. Presence of anterior uveitis or inflammatory bowel disease drives the choice to monoclonal antibody anti-TNFs (MoAb anti-TNFs). In PsA, ustekinumab (UTK), and to a lesser extent ETN, represents the first choice in patients at high infection and TB risk. Anti-TNFs or UTK choice is guided by skin or articular disease severity, enthesitis, and dactylitis, whereas ETN should be preferred if metabolic syndrome or high CV risk complicate PsA. Conclusion: Taking in account of multiple choice driving variables, first-line biologic therapy may be optimized in patients with RA, SpA, and PsA.

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KW - Anti-TNF

KW - Biologics

KW - Psoriatic arthritis

KW - Rheumatoid arthritis

KW - Spondyloarthritis

KW - Tailored therapy

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