PubMed · 16160203
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Louise B Russell. Comparing model structures in cost-effectiveness analysis.. https://doi.org/10.1177/0272989x05281155
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There is increasing evidence for beneficial effects of early DMARD (disease-modifying antirheumatic drug) therapy over delayed treatment in patients who present with arthritis of recent onset. However, no universal consensus exists concerning the choice of initial drug or whether single drugs or combinations should be given as initial treatments. Recent studies have focused on the benefits of various strategies in which treatments were tailored to achieve low levels of disease activity, as assessed using validated response criteria. These studies demonstrated superiority of 'aggressive' over 'conventional' approaches. Whether the inclusion of tumour necrosis factor antagonists or other biologic targeted therapies in such strategies confers additional benefits in terms of improved long-term outcomes must be clarified by further studies. Assessment of risks in the individual patient, allowing individual 'tailoring' of the initial treatment, would be desirable.
Drug discovery and delivery to retard the degeneration of joint tissues are challenging. Current treatment is generally inadequate. This commentary places in perspective the inadequacy characteristic of existing therapeutics and the promising developments embodied in the newer therapeutics administered via the oral or intra-auricular routes.