Rheumatoid arthritis (RA) is more than just joint pain; it is a chronic inflammatory disease that, without proper treatment, can lead to joint damage and other serious health problems. A modern form of treatment, biologic therapy, offers hope and relief to many patients. These drugs are specifically designed to block certain components of the immune system that are involved in inflammation. These drugs are usually used in conjunction with MTX.
Main classes of biologics
Biologics are advanced drugs that are available in different classes, each with a specific target in the immune system. Here are the main classes used in the treatment of rheumatoid arthritis:
TNF inhibitors (tumor necrosis factor inhibitors)
These drugs are designed to block a protein called TNF, which plays a key role in inflammation. These drugs are used to reduce inflammation, relieve pain, improve joint function and prevent further joint damage. Here are some of the most commonly used TNF inhibitors:
- Infliximab (Remicade): A monoclonal antibody that is administered intravenously but also subcutaneously and is used to treat moderate to severe active rheumatoid arthritis, often in combination with methotrexate.
- Etanercept (Enbrel): A fusion protein that is injected subcutaneously and is used to treat moderate to severe rheumatoid arthritis, often as part of a combination therapy with methotrexate.
- Adalimumab (Humira): A monoclonal antibody that is injected subcutaneously and is used to treat various inflammatory diseases, including rheumatoid arthritis.
- Certolizumab pegol (Cimzia): A pegylated Fab fragment of a humanized TNF inhibitor administered subcutaneously for the treatment of rheumatoid arthritis.
- Golimumab (Simponi): A monoclonal antibody that is injected subcutaneously once a month and is used to treat moderate to severe rheumatoid arthritis.
Interleukin inhibitors
This class of biologics targets interleukins, a group of proteins that play a role in communication between cells and promote inflammatory responses. By blocking certain interleukins, these drugs can help reduce inflammation and relieve the symptoms of RA.
- Tocilizumab (RoActemra): This interleukin inhibitor blocks interleukin-6 (IL-6), an inflammatory messenger that is present in high concentrations in rheumatoid arthritis and plays a key role in the inflammatory response and joint damage. Tocilizumab can be administered as an intravenous infusion or as a subcutaneous injection.
- Sarilumab (Kevzara): Similar to tocilizumab, sarilumab targets the interleukin-6 receptor, blocking the action of IL-6 and thus helping to reduce inflammation, pain and swelling. It is administered in the form of a subcutaneous injection.
- Secukinumab (Cosentyx): This interleukin inhibitor blocks interleukin-17A (IL-17A), a cytokine that plays an important role in the development of inflammation and joint damage. Although it is mainly used for the treatment of psoriatic arthritis, there is evidence that it may also be effective in rheumatoid arthritis.
- Ixekizumab (Taltz): Ixekizumab is another IL-17A inhibitor that is mainly used to treat psoriasis and psoriatic arthritis, but also has the potential to be used in rheumatoid arthritis by suppressing the inflammatory response mediated by IL-17A.
B-cell inhibitors
B cells are a type of white blood cell involved in inflammation in RA. B-cell inhibitors such as rituximab aim to block or modify the function of these cells, which can reduce inflammation and improve symptoms.
T-cell inhibitors
T cells are also white blood cells that play a central role in the immune response. T cell inhibitors work by modulating the activation and function of T cells, which can help control inflammation in RA.
Abatacept (Orencia)
This is a selective costimulation modulator that specifically blocks the costimulation of T cells. Abatacept binds to the B7 molecules on antigen-presenting cells and prevents their interaction with CD28 on T cells, which is a necessary condition for the full activation of T cells. Through this inhibition, Abatacept can reduce the overactivity of T cells in RA, leading to a reduction in inflammation and symptom relief.
JAK inhibitors
JAK inhibitors are a newer class of drugs that block enzymes called Janus kinases that are involved in the inflammatory response. These drugs can be taken orally and offer another option for patients who may not respond to other biologics.
Here is a detailed list:
- Tofacitinib (Xeljanz): An oral medication that is administered twice daily.
- Baricitinib (Olumiant): Also an oral medication, but usually taken once a day.
- Upadacitinib (Rinvoq): Another oral medication taken once daily.
- Filgotinib (Jyseleca): Filgotinib is a selective JAK1 inhibitor intended for the treatment of adults with moderate to severe active rheumatoid arthritis who have had an inadequate response to or are intolerant of one or more disease-modifying antirheumatic drugs (DMARDs).
Advantages of biologic therapy
Biologic therapy offers targeted treatment options that specifically target the immunological processes that lead to inflammation and joint damage in rheumatoid arthritis. These drugs can:
- Reduce inflammation
- Reduce pain and stiffness
- Slow down or prevent the progression of joint damage
- Improve the general quality of life
