Clinical Outcomes of biologic disease-modifying therapy in Patients with rheumatoid arthritis
DOI:
https://doi.org/10.5281/zenodo.22813981Keywords:
rheumatoid arthritis, biologic DMARD, TNF inhibitor, clinical outcomes, serious infection riskAbstract
Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) transformed the management of rheumatoid arthritis (RA) by delivering sustained clinical response and structural protection unattainable with conventional synthetic agents alone.
Objective: This review synthesizes the clinical trial and registry evidence on outcomes with biologic DMARD therapy in RA, covering efficacy across drug classes, predictors of response, comparative and combination strategies, and infection risk.
Methods: We synthesized pivotal randomized controlled trials, long-term extension studies, and large national biologics registries addressing TNF-inhibitor and non-TNF biologic efficacy, treatment sequencing, and safety outcomes in RA.
Findings: TNF inhibitors combined with methotrexate produce markedly higher ACR response rates and near-complete arrest of radiographic progression compared with methotrexate alone, non-TNF mechanisms targeting B cells, T-cell costimulation, and interleukin-6 retain efficacy after anti-TNF failure, and serious infection risk, while real and concentrated in the first six months of treatment, is broadly comparable across biologic classes.
Conclusions: Biologic DMARD therapy, introduced early and used within a treat-to-target strategy aimed at sustained remission, delivers substantial and durable gains in disease control and function, with individualized agent selection and sequencing supported by identifiable predictors of response and by evidence favoring mechanism-switching after anti-TNF failure.
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