Biologic and advanced therapy registers in rheumatoid arthritis

The introduction of biologic disease-modifying anti-rheumatic drugs (bDMARDs) has improved outcomes in patients with rheumatoid arthritis (RA), although there are concerns about the long-term safety of these drugs, especially lymphoma and serious infection. Biologic registers have been established to investigate the long-term safety and effectiveness of biologic drugs in RA. To date, publications from biologic registers have focused mainly on anti-tumour necrosis factor (TNF) therapy, although reports of outcomes after other biologic classes are increasing. The reports show that bDMARDs are effective in treatment of RA. However, registry data have shown that bDMARDs are associated with higher rates of serious infection compared with conventional synthetic (cs) DMARDs. Lymphoma risk does not appear to be increased in patients on anti-TNF up to 5 years compared with patients given csDMARDs, but lymphoma risk calculations of non-anti-TNF bDMARDs are not yet reliable due to limited follow-up and numbers of patients taking non-anti-TNF. Moving forward, biologic registers will continue to capture long-term follow-up of bDMARDs in RA, as well as to incorporate new therapies. Furthermore, the introduction of biosimilars will require further long-term evaluation of safety and effectiveness and extend our knowledge in ‘real-life’ situations and across conditions.