A Consensus Report by the RAPID-India Group on Optimising Adalimumab Treatment for Indian Patients with Rheumatoid Arthritis, Axial Spondyloarthritis and Psoriatic Arthritis

Rheumatoid arthritis (RA), axial spondylarthritis (axSpA) and psoriatic arthritis (PsA) significantly impact global health, causing chronic pain and inflammation. Despite effective treatments like adalimumab (ADA), high costs limit its use in India. Moreover, the absence of India-specific guidelines creates subjective biases for effective treatments. To address this lacuna, the RAPID-India steering committee, comprising experienced academic rheumatologists, used a three-phase Delphi process to create a nationwide consensus for ADA treatment for RA, axSpA and PsA. A 22-question survey was sent to 32 rheumatologists nationwide who rated statements on a 5-point Likert scale, with consensus being defined as ≥75% agreement. ADA was recommended for treatment of aggressive early RA and established RA, axSpA and PsA with axial, peripheral and extra-musculoskeletal manifestations. ADA was also recommended for co-morbid conditions like chronic kidney disease (CKD), cardiovascular diseases, fatty liver, osteoporosis and metabolic syndrome (MetS). For patients achieving six consecutive months of remission, a slow tapering of ADA was advised over instant discontinuation to avoid disease flares. ADA is also recommended during pregnancy, right up to the end of the second trimester and during lactation. Furthermore, ADA biosimilars are cheaper and affordable for a larger number of patients in India. This consensus provides evidence-based recommendations to optimise disease outcomes by guiding healthcare professionals with special emphasis and focus only on ADA use in inflammatory arthritis.