15 years experience with biological therapy of inflammatory rheumatic diseases in Czech national register ATTRA

The publication is summarizing application of biological DMARDs in autoimmune inflammatory rheumatic diseases.Up to now conventional therapy, which for example in rheumatoid arthritis was application of methotrexate (MTx) in combination with glucocorticoids, was effective, but the remission as a target was achieved in small proportion of patients and also there was little effect on structural progression of diseases. Biological therapy was great advance because response was achieved in ¾ patients who failed MTx. At present time 8 biological drugs are available. 5 are inhibitors of TNFα and 3 have different move of action. In psoriatic arthritis are beside TNF blockers available blocker of IL 17 (secukinumab, ustekinumab, apremilast). For ankylosing spondylitis is registered secukinumab.Anti-TNF therapy is relative safe but rarely serious adverse events can occur. The most important are serious infections, opportunistic infections and tuberculosis. Other adverse event includes allergic reactions and local intolerance. Increase incidence of lymphomas was not confirmed. There is probably minimal increased risk of skin melanoma and non-melanoma tumors. Benefit/risk ratio is still very positive.National registry of biological therapy ATTRA was founded 15 years ago and includes patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. In June 2016 over all 6800 patients with those diagnoses was included and actually 5194 have been treated. In registry patients are regularly followed for activity, efficacy of the drug and other events. Results of registry are sent payers for evaluations of pharmacologic parameters.