QOL Assessment in Rheumatoid Arthritis 837 ating in this confer the HAQ that were clinically relevant and statistical- ly significant compared with patients who received mspacR methotrexate monotherapy.QOL benefits were also uggested by significant improvements from base. well-being.Is Instruments with on-the-spot scoring line in the physical component summary score and te)shoul a broaden the applicability of pa puter sys outcomes in clinical practice indivdWhile general health.vitality and social unction s were also significantly 5.Do Current Treatments Improve QOL in RA? ent summary score.In contrast.when Han et eutic a nts such as the biolo cal DMARDs.sev studies were in RA)given infliximab at similar eral of which are available for use in the yreatment doses plus methotrexate at various time points for up were found. of RA.Biological DMARDs currently approved to 1 year,different rsu At the firs we in on for the treatment of RA include infliximab time point of e adalimumab.etanercept,anakinra,rituximab and or ents in the aysical com ase progres re.in addition to small though statistically signif onent sum add ntial to in rove HR-QOL has results in Maini et al,paralleled improvements in clinical outcomes with significantly less radiograph- 5.1 Infliximab ic progression and a significantly than ong patien Infliximab is a chimeric(murine/human)mono erapy clonal antibody against TNFo,a cytokine secreted as a reaction to injury during the inflammatory res- 5.2 Adalimumab inflammation and incr ses Adalimumab,like infliximab,is an anti-TNFo ing immune cells to g the TNFo of infl ons of ce ab is cells t57 Adalim ated ing signs and symptoms.inhibiting the for reducing signs and symptoms.inducing major clinical response,inhibiting the progression of struc. tural damage and improving physical function in dult patients with moderately to severely active Functional and QOL outcomes associated with use of infliximab (3 mg/kg or 10 mg/kg every 4 or me mbinatio hile a in a 2 otherapy.as -ye with tha ed th ks of the dalimumab ther apy alone.more Using data from two trials of adalimumab plus from baseline in physical function as measured by methotrexate versus methotrexate alone in patients conomics2008:26(100 QOL Assessment in Rheumatoid Arthritis 837 pating in this conference agreed that standard core the HAQ that were clinically relevant and statistical￾RA criteria do not adequately capture some conse- ly significant compared with patients who received quences of the disease that are of importance to methotrexate monotherapy. QOL benefits were also them, including fatigue, disturbed sleep and sense of suggested by significant improvements from base￾well-being.[51] Instruments with on-the-spot scoring line in the physical component summary score and and technology (such as touch-screen computer sys- individual physical domain components of the tems) should also broaden the applicability of pa- SF-36.[59] While general health, vitality and social tient-reported outcomes in clinical practice.[52] functioning subscale scores were also significantly improved compared with baseline and methotrexate, 5. Do Current Treatments Improve QOL no significant changes were noted on the mental in RA? component summary score. In contrast, when Han et al.[60] analysed results from four studies in patients A better understanding of the pathophysiology of with inflammatory rheumatic disease (of which two RA has resulted in the development of new thera- studies were in RA) given infliximab at similar peutic agents such as the biological DMARDs, sev- doses plus methotrexate at various time points for up eral of which are available for use in the treatment to 1 year, different results were found. At the first of RA. Biological DMARDs currently approved assessment time point of either 6 weeks in one study for the treatment of RA include infliximab, or 10 weeks in the second study, data from these adalimumab, etanercept, anakinra, rituximab and studies showed patients with RA had significant abatacept.[53-58] These agents not only control symp- improvements in the physical component summary toms and slow radiographic disease progression, but score, in addition to small though statistically signif- hold forth the possibility of achieving disease remis- icant improvements in the mental component sum- sion. In addition to their established clinical effi- mary score compared with baseline.[60] The QOL cacy, their potential to improve HR-QOL has been results in Maini et al.[59] paralleled improvements in evaluated in several studies. clinical outcomes with significantly less radiograph￾ic progression and a significantly better ACR res- 5.1 Infliximab ponse rate among patients in the infliximab groups than with methotrexate monotherapy. Infliximab is a chimeric (murine/human) mono￾clonal antibody against TNFα, a cytokine secreted 5.2 Adalimumab as a reaction to injury during the inflammatory res￾ponse. TNFα promotes inflammation and increases Adalimumab, like infliximab, is an anti-TNFα blood vessel permeability, enabling immune cells to agent. Although adalimumab is a fully human anti￾infiltrate the joints.[58] By blocking the actions of body, in contrast to the chimeric properties of inflix￾TNFα, infliximab reduces the number of inflamma- imab, the mechanism of action is the same: binding tory cells migrating into the joints. When combined of TNFα, whether soluble or on the surface of with methotrexate, infliximab is indicated for reduc- TNFα-expressing cells.[57] Adalimumab is indicated ing signs and symptoms, inhibiting the progression for reducing signs and symptoms, inducing major of structural damage, and improving physical func- clinical response, inhibiting the progression of struc￾tion in patients with moderately to severely active tural damage and improving physical function in RA.[58] adult patients with moderately to severely active Functional and QOL outcomes associated with RA, and may be used as monotherapy or in combi￾nation with methotrexate or other DMARDs.[57] use of infliximab (3 mg/kg or 10 mg/kg every 4 or 8 weeks) in combination with methotrexate were While adalimumab is approved for monotherapy, as evaluated in a 2-year study (placebo controlled for observed with other anti-TNFα therapies, combina- 1 year then open label) by Maini et al. tion with methotrexate is more effective than [59] They adalimumab therapy alone.[57] reported that, after 102 weeks of therapy, patients who received infliximab showed improvements Using data from two trials of adalimumab plus from baseline in physical function as measured by methotrexate versus methotrexate alone in patients © 2008 Adis Data Information BV. All rights reserved. Pharmacoeconomics 2008; 26 (10)