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Pathogenetic grounding of biological agents use in rheumatic diseases in terms of current researches and recommendations
Summary. The paper highlights recent EULAR recommendations 2013 for the treatment of rheumatoid arthritis, indicating absence of benefits between biological agents at their first appointment, in addition to that recommendations give preference in the treatment of RA to the combinations of biological agents with synthetic DMARD. It is indicated that rituximab has advantages over other biological agents in certain cases. Recent studies show that rituximab is more effective in patients with seropositive RA compared to seronegative and the combination leflunomide + rituximab versus rituximab + methotrexate has higher possibility of a synergistic effect. In studies of 2012–2013 years the advantage of tocilizumab therapy over TNF-a blockers therapy and the absence of clinical benefits of combination tocilizumab + methotrexate monotherapy over tocilizumab monotherapy and more frequent transaminase elevations combined with tocilizumab+ methotrexate were shown. In the treatment of elderly patients which take high doses of glucocorticoids or/and have the upper respiratory tract pathology it is better to choose tocilizumab to avoid serious infections.
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