Editorial. drug survival. treatment of rheumatic diseases in the biologic era

The development of personalized medicine to improve the outcome of patients with chronic inflammatory rheumatic diseases is yet far to come. Personalized treatment strategies are supposed to foster the possibility of addressing the right therapies to the right patients (1), identifying, in the first place, subgroups of patients for whom a different treatment strategy would be beneficial. Biologic agents targeting various molecules involved in the pathogenesis of many inflammatory diseases are meant to respond to this need. However, despite representing a major advance in the treatment of these conditions, a significant proportion of patients does not achieve the identified target of remission or low disease activity (2–4). In the absence of biomarkers thatmay be predictive of response to any of these drugs, treatment survival is considered a surrogate outcome measure of both effectiveness and safety, especially in the real-world setting, which allows a prolonged observation of patients compared to randomized clinical trials. Also, prolonged treatment survival may help recognize the characteristics of patients associated with a better clinical outcome, thus supporting the decision on drug choice. This is a critical issue in an era that sees an expanding landscape of treatment opportunities for many patients with inflammatory diseases.