Risikostratifizierung für Therapieentscheidungen bei Rheumatoider Arthritis

Zusammenfassung

Um für die Behandlung der rheumatoiden Arthritis unter der Vielzahl an zugelassenen krankheitsmodifizierenden Antirheumatika die geeignete Therapie auszuwählen, werden Patienten anhand ihres Risikos für einen ungünstigen Krankheitsverlauf stratifiziert. Die Auswahl geeigneter Parameter zur Risikostratifizierung werden in dieser Übersichtsarbeit dargestellt. Beim heutigen Therapieziel einer Remission sind hohe Krankheitsaktivität, Funktionseinschränkungen, Begleiterkrankungen und Übergewicht relevante Faktoren für einen ungünstigen Verlauf. Weitere Einflussfaktoren auf die Therapieentscheidung wie Begleiterkrankungen, Infektionsrisiko und spezielle Risikokonstellationen wie vorausgegangene schwerwiegende Infektionen oder Malignome werden in diesem Artikel diskutiert.

Abstract

In order to select the appropriate drug for the treatment of rheumatoid arthritis, patients are stratified according to their risk of an unfavourable course. This review paper presents the selection of suitable parameters for risk stratification. In the light of the current therapeutic target of remission, relevant factors for an unfavourable course include high disease activity, functional limitations and the presence of comorbidities and obesity. Also this article discusses further factors influencing treatment decisions, e. g. concomitant diseases, risk of infection and special risk constellations such as previous serious infections or malignancies.

Schlüsselwörter

DMARDs - biologics - disease activity - infections - comorbidity

Key words

DMARDs - Biologika - Krankheitsaktivität - Infektionen - Komorbidität

• Literatur

• 1 Fiehn C, Holle J, Iking-Konert C. et al. S2e-Leitlinie: Therapie der rheumatoiden Arthritis mit krankheitsmodifizierenden Medikamenten. Z Rheumatol 2018; 77: 35-53
• 2 Smolen JS, Landewe RBM, Bijlsma JWJ. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020; 79: 685-699
• 3 Albrecht K, Zink A. Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies. Arthritis Res Ther 2017; 19: 68
• 4 Baganz L, Richter A, Albrecht K. et al. Are prognostic factors adequately selected to guide treatment decisions in patients with rheumatoid arthritis? A collaborative analysis from three observational cohorts. Semin Arthritis Rheum 2019; 48: 976-982
• 5 Singh JA, Saag KG, Bridges SL. et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol 2016; 68: 1-26
• 6 Castrejon I, Dougados M, Combe B. et al. Prediction of Remission in a French Early Arthritis Cohort by RAPID3 and other Core Data Set Measures, but Not by the Absence of Rheumatoid Factor, Anticitrullinated Protein Antibodies, or Radiographic Erosions. J Rheumatol 2016; 43: 1285-1291
• 7 Lautenschlager J, Mau W, Kohlmann T. et al. Vergleichende Evaluation einer deutschen Version des Health Assessment Questionnaires (HAQ) und des Funktionsfragebogens Hannover (FFbH). Z Rheumatol 1997; 56: 144-155
• 8 Meissner Y, Zink A, Kekow J. et al. Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritis. Arthritis Res Ther 2016; 18: 183
• 9 Meissner Y, Richter A, Manger B. et al. Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort. Ann Rheum Dis 2017; 76: 1583-1590
• 10 Michelsen B, Kristianslund EK, Sexton J. et al. Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis 2017; 76: 1906-1910
• 11 Jani M, Barton A, Hyrich K. Prediction of infection risk in rheumatoid arthritis patients treated with biologics: are we any closer to risk stratification?. Curr Opin Rheumatol 2019; 31: 285-292
• 12 Strangfeld A, Eveslage M, Schneider M. et al. Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient?. Ann Rheum Dis 2011; 70: 1914-1920
• 13 Richter A, Listing J, Schneider M. et al. Impact of treatment with biologic DMARDs on the risk of sepsis or mortality after serious infection in patients with rheumatoid arthritis. Ann Rheum Dis 2016; 75: 1667-1673
• 14 Zink A, Manger B, Kaufmann J. et al. Evaluation of the RABBIT Risk Score for serious infections. Ann Rheum Dis 2014; 73: 1673-1676
• 15 Rutherford AI, Subesinghe S, Hyrich KL. et al. Serious infection across biologic-treated patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis 2018; 77: 905-910
• 16 Curtis JR, Xie F, Yang S. et al. Risk for Herpes Zoster in Tofacitinib-Treated Rheumatoid Arthritis Patients With and Without Concomitant Methotrexate and Glucocorticoids. Arthritis Care Res (Hoboken) 2019; 71: 1249-1254
• 17 Subesinghe S, Rutherford AI, Byng-Maddick R. et al. Biologic prescribing decisions following serious infection: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis. Rheumatology (Oxford) 2018; 57: 2096-2100
• 18 Au K, Reed G, Curtis JR. et al. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis 2011; 70: 785-791
• 19 Krüger K, Nusslein H. Kardiovaskuläre Komorbiditäten bei rheumatoider Arthritis. Z Rheumatol 2019; 78: 221-227
• 20 Listing J, Strangfeld A, Kekow J. et al. Does tumor necrosis factor alpha inhibition promote or prevent heart failure in patients with rheumatoid arthritis?. Arthritis Rheum 2008; 58: 667-677
• 21 Baniaamam M, Paulus WJ, Blanken AB. et al. The effect of biological DMARDs on the risk of congestive heart failure in rheumatoid arthritis: a systematic review. Expert Opin Biol Ther 2018; 18: 585-594
• 22 Wadstrom H, Frisell T, Askling J. et al. Malignant Neoplasms in Patients With Rheumatoid Arthritis Treated With Tumor Necrosis Factor Inhibitors, Tocilizumab, Abatacept, or Rituximab in Clinical Practice: A Nationwide Cohort Study From Sweden. JAMA Intern Med 2017; 177: 1605-1612
• 23 Mercer LK, Askling J, Raaschou P. et al. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics: results from a collaborative project of 11 European biologic registers. Ann Rheum Dis 2017; 76: 386-391
• 24 Mercer LK, Regierer AC, Mariette X. et al. Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project. Ann Rheum Dis 2017; 76: 2025-2030
• 25 Silva-Fernandez L, Lunt M, Kearsley-Fleet L. et al. The incidence of cancer in patients with rheumatoid arthritis and a prior malignancy who receive TNF inhibitors or rituximab: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis. Rheumatology (Oxford) 2016; 55: 2033-2039
• 26 Raaschou P, Frisell T, Askling J. et al. TNF inhibitor therapy and risk of breast cancer recurrence in patients with rheumatoid arthritis: a nationwide cohort study. Ann Rheum Dis 2015; 74: 2137-2143
• 27 Regierer AC, Strangfeld A. Rheumatoid arthritis treatment in patients with a history of cancer. Curr Opin Rheumatol 2018; 30: 288-294
• 28 Chatzidionysiou K, Delcoigne B, Frisell T. et al. How do we use biologics in rheumatoid arthritis patients with a history of malignancy? An assessment of treatment patterns using Scandinavian registers. RMD Open 2020; 6 (02) e001363
• 29 Schäfer M, Meissner Y, Kekow J. et al. Obesity reduces the real-world effectiveness of cytokine-targeted but not cell-targeted disease-modifying agents in rheumatoid arthritis. Rheumatology (Oxford) 2020; 59: 1916-1926
• 30 Luque Ramos A, Hoffmann F, Albrecht K. et al. Transition to adult rheumatology care is necessary to maintain DMARD therapy in young people with juvenile idiopathic arthritis. Semin Arthritis Rheum 2017; 47: 269-275
• 31 Luque Ramos A, Redeker I, Hoffmann F. et al. Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey. J Rheumatol 2019; 46: 564-571
• 32 Luque Ramos A, Albrecht K, Zink A. et al. Rheumatologic care of nursing home residents with rheumatoid arthritis: a comparison of the year before and after nursing home admission. Rheumatol Int 2017; 37: 2059-2064