Abstract
Purpose
Treatments for rheumatoid arthritis (RA) over the last few decades have transformed
the future outlook of the disease. Although patients with clinically apparent RA have
a number of therapeutic options, all are associated with the risk of adverse events
(AEs). Such therapeutics, facilitated by the identification of novel biomarkers and
environmental and genetic factors to predict RA, may allow early detection, prompt
treatment, and prevention before the future development of clinically apparent disease.
Before choosing such treatments to make informed decisions in this context, however,
accurate quantification of benefits and harms of such treatments is vital for participants
without symptoms. This review summarizes the AEs reported in trials in preclinical
or very early RA, the frequency and risk of primary AEs of concern associated with
disease-modifying antirheumatic drugs (conventional, biologic, and targeted), glucocorticoids,
and analgesia in clinically apparent RA. Also summarized is the evidence to date to
support the quantification of benefit and harms incorporating patient preferences.
Methods
This analysis is a narrative review in which individual searches were performed in
PubMed and EMBASE for each drug and topic outlined in the review.
Findings
Current therapies in RA can result in a considerable burden of AEs (serious and nonserious)
depending on the individual's baseline risk. The absolute risk of serious AEs to treatments
reported in individuals at risk of RA, undifferentiated, or very early inflammatory
arthritis trials was low; however, nonserious AEs were not consistently reported.
If such therapies prove effective at preventing the onset of RA in high-risk patients,
incorporating patient preferences as well as robust quantification of benefits and
harms to inform decisions is imperative. Patients' perceptions about treatment in
this context may be risk averse or benefit driven. The risk of AEs that may not reverse
after drug cessation, such as serious infection and malignancy, seem to be important
AEs in such decision-making.
Implications
The impact of AEs in response to potentially preventative treatment is an important
consideration for individuals at high risk of developing RA with minimal symptoms.
Robust quantification of treatment effect given baseline risk versus the risks of
developing all AEs (including those that may affect quality of life), while incorporating
participants’ views, will be necessary for future informed decision-making.
Key Words
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Article info
Publication history
Published online: June 09, 2019
Accepted:
April 10,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
