How should one optimally “sequence” therapy in patients who require biologic therapy? Is there a “one-sequence-fits-all” strategy? Or can one start with any of the biologic agents as an initial therapy in conjunction with methotrexate?
What key clinical parameters, biomarkers, symptoms, and patient-reported outcomes do you prioritize when determining the need for escalating therapy in RA?
What clinical trials have been conducted and/or are currently in progress evaluating IL-6 inhibitors for the management of RA? Can you discuss both tocilizumab and sarilumab and the specific trial designs?
What are the side effects of TNF inhibitors and how do you manage risk for infection? And how does this side effect profile compare to that of IL-6 inhibitors?
When should DMARDs be used as monotherapy in RA patients? What is the optimal patient profile for combination therapy? How do you biomarkers to guide your decisions? And which biologics have been shown to be successful as monotherapy?
With respect to ACR treatment guidelines for RA, do you differentiate between conventional synthetic and biologic DMARDs?
Do you modify your dose of IL-6 inhibitor if you encounter elevations in LDL level?
Can we use biomarkers in any way to help align therapy in RA with a specific therapeutic agent?
Are there markers in RA that suggest a more progressive or aggressive disease course or that will predict non-responsiveness?
What percentage of patients who have had an inadequate response to an initial biologic agent such as TNF seem to respond to biologics with a different MOA, such as an IL-6 inhibitor?
How does one optimize the safety profile of IL-6 inhibitors?
How do TNFIs and IL-6 inhibitors compare as far as their effectiveness when used as monotherapy?