Biologic monotherapy for the treatment of rheumatoid arthritis

Andrew Taylor, Graeme Jones

Methotrexate monotherapy for rheumatoid arthritis is considered efficacious and safe, but an inadequate treatment response and intolerance are common. Patients unresponsive to methotrexate or other disease-modifying antirheumatic drugs may receive biologic disease-modifying antirheumatic drugs (bDMARDs) as monotherapy, or in combination with methotrexate. Of the 17 bDMARD monotherapy clinical trials reviewed here, studies with tocilizumab consistently demonstrated superiority over methotrexate for clinical signs, symptoms and radiographic progression. Evidence for clinical outcomes with anti-TNF agents is less consistent, although adalimumab and etanercept slow radiographic progression. Evidence for other bDMARDs is limited, but rituximab and abatacept may have clinical efficacy. In conclusion, available data suggest tocilizumab is the treatment of choice where methotrexate is considered unsuitable as a co-therapy.