Switching biological disease-modifying antirheumatic drugs and Janus kinase inhibitors in patients with rheumatoid arthritis

The goal of treatment of rheumatoid arthritis (RA) is to achieve remission or low disease activity. A wide range of disease-modifying antirheumatic drugs is used for the treatment of RA, including biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi). However, even with the use of bDMARDs and JAKi, this goal can be achieved only in 40–60% of patients. Insufficient response to bDMARs and JAKi is the reason for switching to other drugs from the same group, such as tumor necrosis factor-α inhibitors, and to drugs with a different mechanism of action. The need to change therapy may be associated with its ineffectiveness due to various immune, genetic and epigenetic mechanisms, with the development of adverse reactions, as well as with comorbid pathology. To date, there is no certain predictors of effectiveness of a particular bDMARDs and JAKi and of the need and strategy for changing the therapy.The review considers the effectiveness of various classes of bDMARDs and JAKi in RA, the frequency and risk factors associated with the need to switch patients to other drugs, the role of chemokines as promising markers of response to RA treatment.