RAPID and FAST4WARD Trials: Certolizumab Pegol for Rheumatoid Arthritis
RAPID and FAST4WARD Trials: Certolizumab Pegol for Rheumatoid Arthritis
In the last decade, biological therapies have dramatically changed the treatment for rheumatoid arthritis (RA) in such a way that remission is currently an achievable goal. The armamentarium of therapeutic options for RA has recently been enriched with another approved anti-TNF-α agent, certolizumab pegol (CZP). This article reviews the trials conducted with CZP in RA, the Rheumatoid Arthritis PreventIon of structural Damage (RAPID 1 and 2) and the EFficAcy and Safety of cerTolizumab pegol – 4 Weekly dosAge in RheumatoiD arthritis (FAST4WARD). These trials have demonstrated that this new biological agent significantly improves the clinical signs and symptoms of RA, inhibits progression of structural damage, and improves physical function and quality of life in patients with active RA who have failed treatment with methotrexate. The safety profile of CZP is acceptable and similar to that of other anti-TNF-α agents.
Rheumatoid arthritis (RA) is the most common of all chronic inflammatory joint diseases, with an estimated prevalence of approximately 0.5–1% worldwide. RA is characterized by joint pain, stiffness and swelling due to synovial inflammation and effusion. Despite mainly affecting the joints, systemic manifestations, such as anemia, cardiovascular disease and osteoporosis also play an important role in RA. Associated pain, functional impairment, fatigue and depression are common consequences of RA and these may lead to substantial reductions in quality of life.
The 'natural history' of RA is characterized by a progressive disease in which uncontrolled inflammation leads to joint damage that is generally irreversible and often occurs early in the disease process. Between 10 and 26% of patients with RA develop erosions within 3 months from the onset of disease and approximately 75% do so within 2 years. Both disease activity and joint damage lead to impairment of physical function. Consequently, permanent disability may develop, which may further progress with a longer duration of active disease if it remains untreated. Furthermore, the chronic and progressive course of RA is also characterized by premature death if insufficiently treated. As a consequence, RA is associated with considerably high direct and indirect costs, especially if insufficiently treated. Work disability, involving loss of working capacity and early retirement, is estimated to affect 30–40% of patients who have had RA for 5 years. A significant economic impact of the disease can particularly be seen during the first year of symptoms. The severity of joint inflammation has been identified as a predictor of work disability, which might suggest that early symptomatic control of the disorder could possibly enable patients to remain active at work. Overall, RA creates a heavy burden on the physical and emotional wellbeing of patients and leads to significant social and economic costs.
Abstract and Introduction
Abstract
In the last decade, biological therapies have dramatically changed the treatment for rheumatoid arthritis (RA) in such a way that remission is currently an achievable goal. The armamentarium of therapeutic options for RA has recently been enriched with another approved anti-TNF-α agent, certolizumab pegol (CZP). This article reviews the trials conducted with CZP in RA, the Rheumatoid Arthritis PreventIon of structural Damage (RAPID 1 and 2) and the EFficAcy and Safety of cerTolizumab pegol – 4 Weekly dosAge in RheumatoiD arthritis (FAST4WARD). These trials have demonstrated that this new biological agent significantly improves the clinical signs and symptoms of RA, inhibits progression of structural damage, and improves physical function and quality of life in patients with active RA who have failed treatment with methotrexate. The safety profile of CZP is acceptable and similar to that of other anti-TNF-α agents.
Introduction
Rheumatoid arthritis (RA) is the most common of all chronic inflammatory joint diseases, with an estimated prevalence of approximately 0.5–1% worldwide. RA is characterized by joint pain, stiffness and swelling due to synovial inflammation and effusion. Despite mainly affecting the joints, systemic manifestations, such as anemia, cardiovascular disease and osteoporosis also play an important role in RA. Associated pain, functional impairment, fatigue and depression are common consequences of RA and these may lead to substantial reductions in quality of life.
The 'natural history' of RA is characterized by a progressive disease in which uncontrolled inflammation leads to joint damage that is generally irreversible and often occurs early in the disease process. Between 10 and 26% of patients with RA develop erosions within 3 months from the onset of disease and approximately 75% do so within 2 years. Both disease activity and joint damage lead to impairment of physical function. Consequently, permanent disability may develop, which may further progress with a longer duration of active disease if it remains untreated. Furthermore, the chronic and progressive course of RA is also characterized by premature death if insufficiently treated. As a consequence, RA is associated with considerably high direct and indirect costs, especially if insufficiently treated. Work disability, involving loss of working capacity and early retirement, is estimated to affect 30–40% of patients who have had RA for 5 years. A significant economic impact of the disease can particularly be seen during the first year of symptoms. The severity of joint inflammation has been identified as a predictor of work disability, which might suggest that early symptomatic control of the disorder could possibly enable patients to remain active at work. Overall, RA creates a heavy burden on the physical and emotional wellbeing of patients and leads to significant social and economic costs.
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