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Biologic Therapy for Rheumatoid Arthritis

Clinical Efficacy and Predictors of Response

BioDrugs volume 23, pages 111–124 (2009)Cite this article

Abstract

Rheumatoid arthritis (RA) is a chronic, disabling disease of the synovial joints, thought to be autoimmune in origin. The emergence of biologic therapies has proven to be highly successful in effectively treating RA in the majority of cases. However, the cost of these agents is high and some patients do not respond to these drugs, or they suffer from adverse events. This article will review the currently available data on efficacy and the clinical, genetic, and biomarkers of response to these biologic therapies in RA.

The anti-tumour necrosis factor-alpha (anti-TNFα) agents, adalimumab, etanercept and infliximab, act to neutralize the pro-inflammatory cytokine. Response to these agents is higher in patients receiving concurrent disease modifying anti-rheumatic drugs or non-steroidal anti-inflammatory drugs, in those with lesser disability, and in non-smokers. Many genetic predictors of response have been investigated, such as the shared epitope, the TNF gene and its receptors, but none have been absolutely confirmed. Synovial expression of TNFα has been suggested as a biomarker of response, while anti-cyclic citrullinated peptide antibody and rheumatoid factor (RF)-positivity predict poor response. Newer biologic agents include the interleukin (IL)-1 receptor antagonist anakinra, the B-cell depleting agent rituximab, the selective costimulation modulator abatacept, and the anti-IL-6 receptor monoclonal antibody tocilizumab. No genetic studies of response to these agents have been performed to date. However, it has been reported that low synovial infiltration of B cells and complete B-cell depletion after the first rituximab infusion are predictors of good response to this agent.

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No sources of funding were used to assist in the preparation of this review. The authors declare no conflicts of interest that are directly relevant to the content of this review.

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  1. ARC Epidemiology Unit, Epidemiology Research Group, School of Translational Medicine, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK

    Laura J. Gibbons & Kimme L. Hyrich

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Gibbons, L.J., Hyrich, K.L. Biologic Therapy for Rheumatoid Arthritis. BioDrugs 23, 111–124 (2009). https://doi.org/10.2165/00063030-200923020-00004

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Keywords

  • Rheumatoid Arthritis
  • Infliximab
  • Etanercept
  • Adalimumab
  • Tocilizumab