Biologics in Rheumatology

Book excerpt: Significant progress has been acquired in the treatment of rheumatic conditions with the introduction of biologic therapies, which has enabled better control of disease activity and improved patients' long-term outcome. Apart from several biologic treatments already licensed for use in autoimmune rheumatic conditions, numerous other agents are currently under investigation. This rapid expansion of the therapeutic armamentarium requires a critical analysis of individual biologic options and their clinical indications, in order to facilitate the optimal use of these new therapies. The authors felt that a comprehensive book revisiting all the evidence available regarding the efficacy, cost-effectiveness and health implications of the use of biologics in rheumatology was needed in order to integrate the clinical, ethical and socio-economic aspects related to their use. This book is aimed at specialist doctors, trainees, nurses and health professionals working in the field of rheumatology. It critically appraises the level of evidence behind the use of biologic agents in diverse autoimmune diseases, comprising separate chapters which focus on rheumatoid arthritis, systemic lupus erythematosus, myositis, systemic sclerosis, Sjogren's syndrome, seronegative spondyloarthropathies, psoriatic arthritis and psoriasis, small, medium and large vessel vasculitis, osteoporosis, and interstitial lung disease associated with rheumatic conditions. In addition, the book explores aspects related to the use of biologic agents, such as ethical considerations of consenting patients to take part in clinical trials with biologics, and adolescent and adult rheumatology nurse perspectives related to patients' benefits of biologic therapies. Particular interest is given to the use of biologics during pregnancy and assessment of their infectious risks. A separate chapter explores the off-target benefits associated with the use of anti-TNF therapies. Several chapters include data about cost-effectiveness, and national and international guidelines for the use of biologic agents in different rheumatic conditions.