Rheumatoid Arthritis Biologics
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Biological chips: a new model of treatment of rheumatoid arthritis
Before the development of newer biologic drugs, rheumatologists have been relegated to the use of disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis (PR).
These DMARDs (drugs such as methotrexate, hydroxychloroquine [Plaquenil], sulfasalazine [Azulfidine]), were and continue to be useful for reducing signs and symptoms of the disease, but lack the ability to put the disease into remission.
About 15 years ago, however, the landscape changed with the advent of biological therapies, targeted therapies that act on specific targets in the immune cascade.
The measure of disease activity and treatment efficacy is spent measuring purely inflammation also using devices such as the quality of health questionnaires related to life.
The use of these questionnaires provides an overview based a patient's physical, subjective sensation of pain, emotional health, social function, and fatigue.
Although these questionnaires are subjective, objective measures of disease are also included. In addition to blood markers such as C-reactive protein and erythrocyte sedimentation rate (ESR), which was once a stand-bys, clinical measures such as Disease Activity Score (DAS) that incorporates a combination of objective measures of joint inflammation and blood markers have allowed more accurate assessments on the status of a patient.
In addition, the use of ultrasound Diagnostic imaging and magnetic resonance allowed rheumatologists to make treatment decisions that are based on objective data, rather that gestalt.
Analysis of epidemiological data in the past has shown that RA increases the probability of a patient with a myocardial infarction (heart attack).
According to recent preliminary data that the use of biological drugs in combination with methotrexate reduced the likelihood of this event much more than the use of conventional DMARD treatment by itself.
In addition, there were significant reductions in hospitalization rates for pneumonia, and reducing the incidence of relapses of inflammatory eye disease due to rheumatoid arthritis.
Current biological therapies are highly effective in the treatment of RA, but the alternatives are still necessary for patients who have either primary non-response (not responding to the right drug the fall) or secondary non-response (lose its effectiveness over time).
In addition to the first wave of biological therapies that are composed of drugs that block the tumor necrosis factor (TNF) more recent biologic therapies such as rituximab (Rituxan) and abatacept (Orencia) may provide additional benefits because of differences in the mechanism of action.
These drugs are generally reserved for patients who lack anti-TNF therapy.
One of the major obstacles that biologic drugs in general need to circumvent the increased propensity to infection, particularly tuberculosis with drugs anti-TNF. In addition, an increased incidence of other fungal infections such as histoplasmosis and coccidiodomycosis has also been noted.
In addition, new drugs in the class of anti-TNF as certoluzimab (Cimzia) and golimumab may also be welcome additions to the arsenal weapons rheumatologists.
Cimzia appears to have a couple of interesting properties because it seems to have a rapid onset of action and also cause less pain at the injection site.
Another biological product, tociluzumab, a humanized antibody that blocks interlekin-6, has proved its effectiveness in Patients who did not respond to anti-TNF therapy.
Denosumab, which is a drug that blocks a substance called RANK ligand inhibits the destruction bone in patients with rheumatoid arthritis and may also be effective in treating osteoporosis.
Finally, a class of drugs, called "small molecules" – oral agents that block protein kinases have profound effects on the immune system and have shown impressive effects in rheumatoid arthritis. They have the added advantage of being oral. Unfortunately, they may, because of their mode of action, have also undesirable side effects … Further investigation underway.
About the Author
Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info:
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