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Recent advances in rheumatoid arthritis
1. Recent advances in rheumatoid arthritis
DR. Satyabrata sahoo
DM Resident Clinical Pharmacology
Department of Clinical & Experimental Pharmacology
School of Tropical Medicine, Kolkata
10/29/2021 1
2. Content
• Introduction
• Pathophysiology
• Clinical feaures
• Lab findings
• Complications
• Quality of life
• Recent advances in management
• Clinical trials
• summary
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3. Introduction
• Rheumatoid arthritis (RA): a chronic autoimmune inflammatory disorder of
unknown etiology that occurs in approximately 1% of the population (Albani and
Carson 1997).
• Common autoimmune disease associated with progressive disability, systemic
complications, early death and socioeconomic costs.
• More prevalent among women than men
• Develops in the fourth and fifth decades of life(Kavanaugh and Lipsky 1996).
• Symptoms are pain, stiffness, and swelling of the joints resulting in impaired
physical function.
• Often accompanied by constitutional symptoms such as fever and malaise (Grassi
et al. 1998).
• Synovial inflammation
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22. • Background: To evaluate the effect of Filgotinib vs placebo on the
signs and symptoms of RA in a treatment refractory population
• Method: Randomised placebo controlled multinational phase 3 trial
• Intervention: Filgotinib 200mg(n=148), Filgotinib 100mg(n=153)or
placebo(n=148)
• Result: Among 448 patients 360 women [80.4%]; mean [SD] DAS28-
CRP score, 5.9 [0.96]; 105 [23.4%] with3 prior bDMARDs), 381(85%)
completed the study.
• At week 12, more patients receiving filgotinib, 200mg (66.0%) or
100mg (57.5%), achieved ACR20 response (placebo, 31.1%)P < .001
• Conclusion: significantly greater proportion of clinical response by
Filgotinib
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23. Background: Methotrexate+adalimumab is more effective than ADA monotherapy.
Assessment of toxicity of different doses of Methotrexate and treatment efficacy of
ADA+MTX in two trials
Method: Data originated from Concerto, efficacy assessed by ACR50
Result: In CONCERTO, ACR50 rates increased over time,ranging from 54% to 68% at
week 26, while AE rates remained steady, ranging from 2.4% to 17.8% at week 26
• In MUSICA, ACR50 rates increased over time, and were 32.3% and 37.5% at week
24, while MTX related AE rates remained steady and were 6.5% at week24
Conclusion: In patients with RA initiating ADA+MTX combination, treatment
efficacy was achieved and increased throughout both trials, while rates of MTX
related AEs remained steady.
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24. Summary
• The recent developments in the management strategies for
rheumatoid arthritis have made significant contribution to reducing
the disease progression and improving outcomes of the patients.
• Identifying the candidates early in 'window of opportunity" and
aggressive target oriented approach can prove to be a boon to the
patients in long run.
• The addition of biologic agents to the armamentarium of available
disease modifying agents early in course of the disease can result in
satisfying functional recovery and even remission in patients of RA.
• With judicious use of medications and careful monitoring quality of
life of patients with RA can be surely improved.
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