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A tailored approach needed to achieve an optimal biologics response

Dr Patrick Kiely, Consultant Rheumatologist, St George’s Hospital, London, UK, gave a practical presentation titled ‘Getting it right first time — predictive factors for initiating biologic therapy’.

He highlighted EULAR data on poor prognostic factors in rheumatoid arthritis (RA), which include early joint damage, high disease activity and being antibody (ACPA/RF)-positive.

Commenting on the impact of obesity in rheumatology, Dr Kiely said research shows that it “decreases the odds of achieving remission in RA patients and is associated with increased pain, impaired functional ability and decreased quality of life”.

He also highlighted how obesity negatively impacts rheumatology patients’ response and adherence to biologic therapy, and that treatments, which change dosage according to weight, as opposed to fixed dosing, are going to be more successful in this patient cohort. Biologic IV infusions are easier to monitor and ensure compliance, so they should be strongly considered in patients where adherence is likely to be an issue, he told the Meeting.

Dr Kiely cited studies on the impact of bariatric surgery weight loss in RA patients, which showed improved disease activity, reduced inflammatory markers and decreased medication usage.

Discussing other factors that predict the response rates to biologics, he said that smoking negatively influences anti-TNFs, though less so in rituximab. 

Concluding, he said there is “no one-sized approach to managing rheumatology patients”, and “doctors must adopt a holistic approach to assessing the patient and based on shared decision-making determine a suitable treatment”.

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