Optimaal gebruik van biologicals bij reumatoïde artritis

In general, patients with Rheumatoid Arthritis (RA) can achieve a well-controlled disease thanks to the various available treatment options, and an effective treat-to-target strategy. One class of treatment options are biologic Disease-Modifying Antirheumatic Drugs (bDMARDs), which are very effective drugs, but many questions remain regarding their optimal use. Firstly, once initiated, bDMARDs are often used on the long term even when patients are in sustained disease control, albeit at a high societal cost and risking potential dose-dependent serious infections. Secondly, patients with early RA and an insufficient response to initial treatment require in current practice several treatment adaptations before they are eligible for bDMARD reimbursement, risking to miss their window-of-opportunity, which can lead to incomplete tackling of disease impact and remaining unmet needs. Lastly, another point to consider is that the bDMARD rituximab was initiated as treatment for RA based on few classic dose-finding studies, leaving room for improvement of its retreatment strategy and dosing regimen. Therefore, the main objective of this PhD dissertation was to optimise the bDMARD-use both in patients with early and established RA by investigating bDMARD-use in daily clinical practice, exploring novel treatment strategies, and questioning patients and rheumatologist about their perceptions on bDMARD-use.