Advances in Biologic Agents for the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis is characterized by pain, swelling, and destruction of joints, with resultant disability. Only disease-modifying antirheumatic drugs can interfere with the disease process. Advances in the current knowledge of pathogenetic mechanisms of rheumatoid arthritis have contributed to the development of biologic agent therapy, and translated research findings into clinical practice. Therapeutics options for rheumatoid arthritis (RA) have increased tremendously in the past decade with the introduction of biologic agents in 1999. Especially inhibitors of tumor necrosis factor have allowed for hitherto unseen therapeutic benefit, although even with these drugs the frequency and degree of responses are restricted. Therefore, new agents are needed. And novel biologic agent compounds for treatment RA have already been used in practice or are on the horizon. TNF-α (infliximab, etanercept, adalimumab), IL-1 (anakinra) and IL-6 (tocilizumab) inhibitors, a B-cell depleting agent (rituximab) and a drug blocking T-cell costimulation (abatacept) have been approved for rheumatoid arthritis. The progress in manufacturing biotechnology has contributed to the development of several other prospective agents that may form the basis for the therapy of rheumatoid arthritis in the near future. The newer biologic agents appear to be well tolerated in the short to medium term (up to 1 year), with an acceptable tolerability profile. However, larger studies with longer follow-up times are needed to indicate both effects and adverse effects of these agents.