Long Term Efficacy in Adalimumab for Rheumatoid Arthritis Therapy
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Great advances in the treatment of chronic autoimmune inflammatory arthritis, concerning both therapeutic concepts and means, have marked the last two decades. In the 1990s the inversion of the classical “therapeutic pyramid” for the treatment of rheumatoid arthritis (RA) became mainstream in rheumatologypractice,whilelatertheconcept“treatearlytotreateffectively”wasrealizedasanecessity in order to achieve favorable outcomes in RA both in the short and long term. Concerning medications methotrexate (MTX) was regarded as the “anchor drug” for the treatment of RA,while other disease- modifying anti-rheumatic drugs (DMARDs) such as cyclosporine A and leflunomide were recruited or developed to add further therapeutic benefit against chronic inflammatory arthritis as monotherapy or in combination.1 Despite the implementation of these new therapeutic concepts and agents there were issues still to be addressed. A considerable proportion of patients with RA could experience no significant benefit: for example in randomized controlled trials in early RA, 35% of patients receiving MTX monotherapy failed to achieve a 20% American College of Rheumatology (ACR) response at year 1 and 44% at year 2.