Current guidelines recommend treating
rheumatoid arthritis (RA) patients to reach low disease activity or remission, however, most
biologic-naive RA patients fail to reach treatment targets on their first
biologic therapy. Approximately 90% of
biologic-naive RA patients receive a
tumor necrosis factor alpha inhibitor (anti-TNF) as their first
biologic treatment, even though several alternative mechanism of action (MOA)
therapies are approved as first-line options. After 3 months of
therapy, patients may remain on anti-TNF
therapy even if they fail to achieve the treatment target, mainly due to formulary structures. This means patients have to endure a second and even a third ineffective anti-TNF-called anti-TNF cycling-before changing MOA. This significantly delays patients from reaching their treatment targets. All anti-TNF drugs target the same molecular and inflammatory pathways; thus, it is not surprising that most patients who are primary non-responders to their initial anti-TNF
therapy fail to achieve their treatment targets when cycled through alternative anti-TNFs. This suggests that primary non-responders should be switched to an alternative MOA
therapy rather than enduring anti-TNF cycling. Avoiding anti-TNF cycling would prevent
disease progression and improve quality of life for RA patients who are primary non-responders to anti-TNFs. The development of a
personalized medicine approach to identify primary non-responders to anti-TNFs prior to treatment would allow significantly more patients to reach their treatment target by treating them with alternative MOA
therapies as first-line
therapies.