Abstract
Biologic disease modifying anti-rheumatic drugs have transformed the management of rheumatoid arthritis (RA) since their introduction into clinical practice over a decade ago. Following large-scale clinical trials, a number of biologics, with different mechanisms of action, have been licensed for the condition. In this review, we will summarise the current evidence for biologic use in RA with an emphasis on their efficacy and tolerability. In addition, we will provide a commentary on the current limitations and unmet needs in this area and discuss the future of biologic intervention.
Similar content being viewed by others
References
Askling J, Fahrbach K, Nordstrom B et al (2011) Cancer risk with tumour necrosis factor alpha (TNF) inhibitors: meta-analysis of randomized controlled trials of adalimumab, etanercept, and infliximab using patient level data. Pharmacoepidemiol Drug Safety 20(2):119–130
Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343:1586–1593
Bongartz T, Sutton AJ et al (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. JAMA 295(19):2275–2285
Bresnihan B, Alvaro-Gracia JM, Cobby M et al (1998) Treatment of rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist. Arthritis Rheum 41:2196–2204
Brunasso AMG, Puntoni M, Gulia A (2011) Safety of anti-tumour necrosis factor agents in patients with chronic hepatitis C infection: a systematic review. Rheumatology 50(9):1700–1711
Calabrese LH, Zein N, Vassilopoulos D (2004) Safety of antitumour necrosis factor (anti-TNF) therapy in patients with chronic viral infections: hepatitis C, hepatitis B, and HIV infection. Ann Rheum Dis 63(2):ii18–ii24
Campbell L, Chen C, Bhagat SS, Parker RA, Östör AJ (2011) Risk of adverse events including serious infections in rheumatoid arthritis patients treated with tocilizumab: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatology (Oxford). 50(3):552–562
Chynes RA, Towers TL, Presta LG (2006) Inhibitory Fc receptors modulate in-vivo cytotoxicity against tumor targets. Nat Med 6:443–446
Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC, Keystone EC, Loveless JE, Burmester G-R, Cravets MW, Hessey EW, Shaw T, Totoritis MC (2006) Rituximab for rheumatoid arthritis refractory to anti–tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum 54:2793–2806. doi:10.1002/art.22025
Cohen SB, Moreland LW, Cush JJ, Greenwald MW, Block S et al (2004) A multicentre, double blind, randomised, placebo controlled trial of anakinra (Kineret), a recombinant interleukin 1 receptor antagonist, in patients with rheumatoid arthritis treated with background methotrexate. Ann Rheum Dis 63:1062–1068. doi:10.1136/ard.2003.016014
den Broeder AA, de Jong E, Franssen MJAM, Jeurissen MEC, Flendrie M, van den Hoogen FHJ (2006) Observational study on efficacy, safety, and drug survival of anakinra in rheumatoid arthritis patients in clinical practice. Ann Rheum Dis 65:760–762. doi:10.1136/ard.2004.033662
Emery P, Breedveld FC, Hall S, Durez P, Chang DJ et al (2008b) Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet 372(9636):375–382
Emery P, Fleischmann R, Filipowicz-Sosnowska A, Schechtman J, Szczepanski L, Kavanaugh A, Racewicz AJ, van Vollenhoven RF, Li NF, Agarwal S, Hessey EW, Shaw TM (2006) The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: Results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial. Arthritis Rheum 54:1390–1400. doi:10.1002/art.21778
Emery P, Keystone E, Tony HP, Cantagrel A, van Vollenhoven R et al (2008) IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 67:1516–1523. doi:10.1136/ard.2008.092932
Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D et al (1995) American college of rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 38:727–735
Finckh A, Bansback N, Marra CA, Anis AH, Michaud K et al (2009) Treatment of very early rheumatoid arthritis with symptomatic therapy, disease-modifying antirheumatic drugs, or biologic agents: a cost-effectiveness analysis. Ann Intern Med 151(9):612–621
Fleischmann R, Vencovsky J, van Vollenhoven RF, Borenstein D, Box J, Coteur G et al (2009) Efficacy and safety of certolizumab pegol monotherapy every 4 weeks in patients with rheumatoid arthritis failing previous disease-modifying antirheumatic therapy: the FAST4WARD study. Ann Rheum Dis 68(6):805–811
Gabriel SE, Crowson CS, O’Fallon WM (1999) The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum 42(3):415–420
Garnero P, Thompson E, Woodworth T, Smolen JS (2010) Rapid and sustained improvement in bone and cartilage turnover markers with the anti-interleukin-6 receptor inhibitor tocilizumab plus methotrexate in rheumatoid arthritis patients with an inadequate response to methotrexate: results from a substudy of the multicenter double-blind, placebo-controlled trial of tocilizumab in inadequate responders to methotrexate alone. Arthritis Rheum 62:33–43. doi:10.1002/art.25053
Gea-Banacloche JC (2010) Rituximab-associated infections. Semin Hematol 47:187–198
Genovese MC, Cohen S, Moreland L, Lium D, Robbins S et al (2004) Combination therapy with etanercept and anakinra in the treatment of patients with rheumatoid arthritis who have been treated unsuccessfully with methotrexate. Arthritis Rheum 50(5):1412–1419
Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJSM et al (2005) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt Study). A randomized, controlled trial. Arthritis Rheum 52(11):3381–3390
Gottlieb A, Menter A, Mendelsohn A, Shen YK, Li S et al (2009) Ustekinumab, a human interleukin 12/23 monoclonal antibody, for psoriatic arthritis: randomised, double-blind, placebo-controlled, crossover trial. Lancet 373(9664):633–640
Gout T, Ostor AJ, Nisar MK (2011) Lower gastrointestinal perforation in rheumatoid arthritis patients treated with conventional DMARDs or tocilizumab: a systematic literature review. Clin Rheumatol 30(11):1471–1474
Hale G, Herman W (2000) From laboratory to clinic. The story of CAMPATH-1. Methods in molecular medicine, vol 40. Humana Press, Totowa, pp 243–266
Hericourt J, Richet Ch (1895) “Physologie Pathologique”—de la serotherapie dans la traitement du cancer. Comptes Rendus Hebd Seanc Acad Sci 121:567
Hervey PS, Keam SJ (2006) Abatacept. BioDrugs 20(1):53–61 (discussion 62)
Hirao M, Hashimoto J, Tsuboi H, Nampei A, Nakahara H, Yoshio N et al (2009) Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab. Ann Rheum Dis 68(5):654–657
Hueber W, Patel DD, Dryja T, Wright AM, Koroleva I et al (2010) Effects of AIN457, a fully human antibody to interleukin-17A, on psoriasis, rheumatoid arthritis, and uveitis. Sci Transl Med 2(52):52ra72
Jacobsson LTH, Turesson C, Gülfe A et al (2005) Treatment with tumor necrosis factor blockers is associated with a lower incidence of first cardiovascular events in patients with rheumatoid arthritis. J Rheumatol 32(7):1213–1218
Jones G, Sebba A, Gu J, Lowenstein MB, Calvo A, Gomez-Reino JJ et al (2010) Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis 69(01):88–96
Karanikolas G, Charalambopoulos D, Vaiopoulos G, Andrianakos A, Rapti A et al (2008) Adjunctive anakinra in patients with active rheumatoid arthritis despite methotrexate, or leflunomide, or cyclosporin-A monotherapy: a 48-week, comparative, prospective study. Rheumatology 47(9):1384–1388
McInnes IB, Schett G (2007) Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol 7(6):429–442
Moreland LW, Alten R, Bosch F, Appelboom T, Leon M et al (2002) Costimulatory blockade in patients with rheumatoid arthritis: a pilot, dose-finding, double-blind, placebo-controlled clinical trial evaluating CTLA-4Ig and eighty-five days after the first infusion. Arthritis Rheum 46:1470–1479
National Institute for Health and Clinical Excellence (2010) Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor. Technology appraisal guidance 195. National Institute for Health and Clinical Excellence, London
Ruperto N, Lovell DJ, Quartier P, Paz E, Rubio-Pérez N, Silva CA, et al (2008) Abatacept in children with juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled withdrawal trial. Lancet 372(9636):383–391
Russell A, Emery P, Kafka SP et al (2005) Abatacept improves clinical responses regardless of baseline physical function: results from the AIM trial. Arthritis Rheum 52:S543
Scott DL (2011) Role of spleen tyrosine kinase inhibitors in the management of rheumatoid arthritis. Drugs 71(9):1121–1132
Singh JA, Wells GA, Christensen R et al (2011) Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev 2:CD008794. doi:10.1002/14651858.CD008794.pub2
Smolen JS, Aletaha D, Bijlsma JW et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69(4):631–637
Sweeney SE, Firestein GS (2006) Mitogen activated protein kinase inhibitors: where are we now and where are we going? Ann Rheum Dis 65 (suppl 3):iii83–iii88
Tak PP, Rigby WF, Rubbert-Roth A, Peterfy CG, van Vollenhoven RF et al (2011) Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial. Ann Rheum Dis 70(1):39–46
Taylor A, Jones G (2011) Biologic monotherapy for the treatment of rheumatoid arthritis. Clin Invest. 1(9):1291–1300
van der Heijde D, Klareskog L, Rodriguez-Valverde V, Codreanu C, Bolosiu H et al (2006) Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum 54(4):1063–1074
van de Putte LBA, Atkins C, Malaise M, Sany J, Russell AS, van Riel PLCM et al (2004) Efficacy and safety of adalimumab as monotherapy in patients with rheumatoid arthritis for whom previous disease modifying antirheumatic drug treatment has failed. Ann Rheum Dis 63(5):508–516
Vital EM, Dass S, Rawstron AC, Buch MH, Goëb V, Henshaw K, Ponchel F, Emery P (2010) Management of nonresponse to rituximab in rheumatoid arthritis: predictors and outcome of re-treatment. Arthritis Rheum 62:1273–1279. doi:10.1002/art.27359
Weinblatt M, Combe B, Covucci A, Aranda R, Becker JC, Keystone E (2006) Safety of the selective costimulation modulator abatacept in rheumatoid arthritis patients receiving background biologic and nonbiologic disease-modifying antirheumatic drugs: a one-year randomized, placebo-controlled study. Arthritis Rheum 54(9):2807–2816
Westlake SL, Colebatch AN, Baird J, Kiely P, Quinn M, Choy E, Ostor AJ, Edwards CJ (2010) The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology 49(2):295–307. doi:10.1093/rheumatology/kep366
Westhovens R, Kremer JM, Moreland LW, Emery P, Russell AS et al (2009) Safety and efficacy of the selective costimulation modulator abatacept in patients with rheumatoid arthritis receiving background methotrexate: a 5-year extended phase IIB study. J Rheumatol 36(4):736–742 (Epub 2009 Feb 27)
Woodrick R, Ruderman EM (2010) Anti-interleukin-6 therapy in rheumatoid arthritis. Bull NYU Hosp Jt Dis 68(3):211–217
Zink A, Listing J, Kary S, Ramlau P, Stoyanova-Scholz M et al (2005) Treatment continuation in patients receiving biological agents or conventional DMARD therapy. Ann Rheum Dis 64:1274–1279. doi:10.1136/ard.2004.031476
Acknowledgments
Dr Malaviya’s Clinical Research Fellowship is funded by CARE (Cambridge Arthritis Research Endeavour) E6 Level 6, Addenbrooke’s Hospital, Hills road, Cambridge, UK CB2 0QQ.
Conflict of interest
Andrew Ostor has received support from (including attendance at conferences), undertakes clinical trials and acts as a consultant to Roche, Chugai, MSD, Abbott, Pfizer, BMS, GSK, MerckSorono and UCB.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Malaviya, A.P., Östör, A.J.K. Rheumatoid arthritis and the era of biologic therapy. Inflammopharmacol 20, 59–69 (2012). https://doi.org/10.1007/s10787-012-0123-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10787-012-0123-y