Immunosuppressant Management for Rheumatic Diseases

This trial examines how varying the duration of stopping immunosuppressants before shoulder replacement surgery affects individuals with rheumatic diseases such as rheumatoid arthritis or lupus. It compares the usual stop period with a shorter one to determine which leads to fewer flares, less pain, and fewer complications. Individuals who have taken immunosuppressants for at least three months and are planning a shoulder replacement may be suitable candidates. As a Phase 2 trial, this research focuses on assessing the treatment's effectiveness in an initial, smaller group of participants.

The trial involves stopping immunosuppressant medications for a certain period before surgery, but the exact duration is not specified. If you have severe SLE, you will need to stay on your current treatment.

Research shows that many drugs used in this trial are generally well-tolerated. For example, studies on Abatacept report a 6.7% complication rate after surgery in patients with rheumatoid arthritis, which is relatively low. Anakinra is also considered well-tolerated, with mostly mild reactions at injection sites.

Adalimumab has mixed safety data. Some studies suggest it may increase the risk of infections after surgery, while others show different results. Belimumab has not shown any new safety concerns over five years of use in certain conditions.

Certolizumab commonly causes side effects like respiratory infections and rashes. Similarly, Cyclosporine is considered safe for patients with rheumatoid arthritis who don't respond to standard treatments.

Hydroxychloroquine is known for its good safety record, with no increased risk of infection. Infliximab, when given within four weeks of surgery, does not show a higher risk of serious infections.

Methotrexate has not been linked to an increase in complications after surgery, and Tocilizumab has a low rate of surgical complications at 8.6%.

Researchers are excited about this trial because it explores new ways to manage immunosuppressant use in patients undergoing surgery for rheumatic diseases. Unlike the standard protocol, which requires patients to stop their medication for a longer period before surgery, the experimental approach aims to shorten this hold based on each drug's pharmacokinetics. This could potentially minimize the risk of disease flare-ups while still maintaining safety around surgery. If successful, this trial could lead to a more personalized and effective management strategy for patients, reducing complications and improving recovery times.

This trial will compare two different immunosuppressant management protocols for rheumatic diseases. Research has shown that many treatments in this study effectively manage rheumatic diseases. For example, abatacept reduces inflammation and symptoms in people with rheumatoid arthritis over time. Adalimumab has delivered excellent results in treating rheumatoid arthritis, with many patients responding well. Anakinra also reduces symptoms, though some studies suggest it might not be as strong as adalimumab. Azathioprine manages rheumatoid arthritis by calming the immune system. Belimumab has significantly improved patients with systemic lupus erythematosus, a condition related to rheumatic diseases. Overall, strong clinical evidence supports these medications' effectiveness in treating various rheumatic diseases.⁶⁷⁸⁹¹⁰