Nature Reviews Rheumatology ( IF 29.4 ) Pub Date : 2024-10-24 , DOI: 10.1038/s41584-024-01169-7 Victoria Konzett, Daniel Aletaha
Management of rheumatoid arthritis (RA) has evolved from simply the direct translation of drug efficacy results from clinical trials to patient care, to a more complex longitudinal process that considers not only drug efficacy but also the safety gestalt of a treatment and patient profiles and preferences, as well as health-economic factors. With numerous DMARDs available to treat RA, knowledge about trial efficacy becomes less important than data that inform an appropriate clinical strategy for their optimal selection and use. Overly ambitious approaches targeting the ‘maximum’ level of success could, for example, be prone to failure and create frustration, and lead to a large number of patients then being considered as ‘difficult to treat’. Safety profiles might be more informative than efficacy profiles for precision medicine approaches. Contemporary RA management strategies might therefore take a more holistic approach, beyond merely efficacy, to the setting of targets that lead to improved compliance rather than aspirational successes, with consideration of each patient’s multimorbidity profile and preferences, as well as the safety profile of each treatment. Ultimately, the goal remains unchanged: maximizing health-related quality of life; however, with a focus on optimal balance rather than superlatives.
中文翻译:
类风湿性关节炎的管理策略
类风湿性关节炎 (RA) 的管理已经从简单地将临床试验的药物疗效结果直接转化为患者护理,演变为一个更复杂的纵向过程,该过程不仅考虑药物疗效,还考虑治疗的安全性格式塔、患者概况和偏好,以及健康经济因素。由于有许多 DMARD 可用于治疗 RA,因此有关试验疗效的知识变得不如为最佳选择和使用的适当临床策略提供信息的数据重要。例如,以“最大”成功水平为目标的过于雄心勃勃的方法可能容易失败并造成挫败感,并导致大量患者被认为是“难以治疗”的。安全性概况可能比精准医学方法的疗效概况更具信息量。因此,当代 RA 管理策略可能采取更全面的方法,而不仅仅是疗效,而是设定目标,从而提高依从性,而不是取得理想的成功,同时考虑到每个患者的多病共存情况和偏好,以及每种治疗的安全性。最终,目标保持不变:最大限度地提高与健康相关的生活质量;然而,专注于最佳平衡而不是最高级。