Rheumatoid Arthritis: Treatment Choices

RAEarly treatment for rheumatoid arthritis, studies show, pays off for patients in terms of long-term quality of life and a lower chance of later needing joint replacements. I can attest to this with a more personal perspective. Just yesterday I visited with my aunt who happens to have severe rheumatoid arthritis. For the past seven years she has taken the biologic medication Remicade® (infliximab), which has slowed the progression of this devastating disease. In addition to her current medication plan, my aunt credits her health to excellent care from a rheumatologist, as well as a positive attitude which has added to her quality of life. Thankfully, we were able to venture out and enjoy a good Florida seafood lunch at the beach together.

Standard treatment for rheumatoid arthritis starts with methotrexate and other nonbiologic therapies. For those who do not respond to this first-line treatment, next up are biologic medications such as the Remicade that my aunt takes, as well as tumor necrosis factor (TNF) inhibitors (e.g., Enbrel and Humira) or Rituxan (rituximab).

The latest research comparing biologic medications reports that both TNF inhibitors and Rituxan are equally effective for patients, although Rituxan comes at a lower cost (the total cost goes up if methotrexate is used in combination with Rituxan). Interestingly, earlier this year a study found that a half-dose of Rituxan brought about similar clinical efficacy as full doses to treat rheumatoid arthritis, suggesting more potential cost savings.

How fortunate that the current and ongoing advances in rheumatoid arthritis care for patients, including my dear aunt, have led to treatment choices for patients and physicians to create the best individualized plans for optimal quality of life.


Chatzidionysiou K, et al. Effectiveness of two different doses of rituximab for the treatment of rheumatoid arthritis in an international cohort: data from the CERERRA collaboration. Arthr Res Ther 2016 DOI:10.1186/s13075-016-0951-z.

Coblyn JS. Head-to-head comparison of rituximab vs. TNF inhibitors for rheumatoid arthritis. NEJM Journal Watch June 21, 2016.

Porter D, van Melckebeke J, Dale J, et al. Tumour necrosis factor inhibition versus rituximab for patients with rheumatoid arthritis who require biological treatment (ORBIT): an open-label, randomised controlled, non-inferiority, trial. Lancet 2016;388(10041):239-47.

Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy



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