Abstract
High proportion of patients with rheumatoid arthritis (RA) suffers from systemic symptoms of this disease. These are very common and include fatigue, anemia, depression, osteoporosis, pulmonary symptoms, and elevated cardiovascular risk.
Many of these traits are caused by interleukin 6 (IL-6), which became - quite logically - the target of specific RA treatment. In the first part of his article, the author summarizes the results of pivotal trials with a IL-6 receptor inhibitor sarilumab.
This drug has proved to be effective in a wide range of RA patients - so called methotrexate (MTX)-naïve, MTX-failure, and anti-TNF-failure. In the MONARCH trial, sarilumab in monotherapy was found to be more effective than adalimumab.
In the second part, the author comments on the results of sarilumab treatment in everyday clinical practice in the Czech Republic; the Czech National Registry ATTRA has proved its fast, lasting, and robust clinical effect. As shown by a sub-analysis, the line of treatment in which sarilumab is initiated represents a predictive factor.
The results of the third- or higher-line biological therapy are worse than those of the first or second-line treatment. Other analyzed predictive factors did not have any significant impact on the therapeutic effect.
The final part is dedicated to a case study of a patient successfully treated with sarilumab. His RA was long-standing and with marked systemic symptoms.
Not only has the therapy with conventional synthetic antirheumatic drugs failed; he also developed hepatopathy. Forced monotherapy with biologics (bDMARDs) was ineffective, and so was tocilizumab application.
Only sarilumab made the achievement of the therapeutic goal possible. Sarilumab treatment may be suitable for patients with highly-active RA, pronounced elevation of acute phase reactants, and systemic disease symptoms.
It is prudent not to postpone the sarilumab therapy more than necessary.