A REVIEW OF EFFECTIVENESS AND SAFETY OF SELECTED BIOLOGICS IN THE TREATMENT OF RHEUMATOID ARTHRITIS
Abstract
Background: Rheumatoid arthritis (RA) is an autoimmune disease that causes disability to
patients in the long run. The bone and cartilage degradation are driven by pro-inflammatory
cytokines like tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) among others.
The traditional treatment for RA is disease modifying anti-rheumatic drugs (DMARDs)
despite the serious adverse effects. In the last past few years biologics have been added to
DMARDs or replaced them altogether in the treatment of RA. There is however, growing
concern on the effectiveness and safety of these biologics.
Aim: This article reviewed the use of Rituximab, Adalimumab, and Golimumab, as well as
dnaJP1 peptide and Folate-targeted immunotherapy data to assess their effectiveness and
safety in the treatment of RA.
Methods: Data from clinical trials and other animal model experiments published in peerreviewed journal articles were reviewed to determine the effectiveness and safely levels of
these biologics as used in the treatment of rheumatoid arthritis.
Results: We found that combination therapy of biologics and DMARDs has proven effective
in the treatment of RA especially where the latter have failed to reduce disease activity in
patients. Rituximab has been found effective where monotherapy treatment with DMARDs
and anti-TNFs have failed.
Conclusion: All biologics are generally effective and safe for use in the treatment of RA with
minimal side effects being reported.
Downloads
References
Adalimumab in clinical practice. Outcome in 70 rheumatoid arthritis patients, including
comparison of patients with and without previous anti-TNF exposure. Rheumatology
(Oxford, England), 44(8), 1026–31. doi:10.1093/rheumatology/keh673
Bennett, A. N., Peterson, P., Zain, A., Grumley, J., Panayi, G., & Kirkham, B. (2005).
Adalimumab in clinical practice. Outcome in 70 rheumatoid arthritis patients, including
comparison of patients with and without previous anti-TNF exposure. Rheumatology,
44, 1026–1031. doi:10.1093/rheumatology/keh673
Buch, M. H., Vital, E. M., & Emery, P. (2008). Abatacept in the treatment of rheumatoid
arthritis. Arthritis Research & Therapy, 10 Suppl 1, S5. doi:10.1186/ar2416
Chatzidionysiou, K. (2012). Biologic Treatment in Rheumatoid Arthritis.
Chen, Y.-J., Chang, Y.-T., Wang, C.-B., & Wu, C.-Y. (2011). The risk of cancer in patients
with rheumatoid arthritis: a nationwide cohort study in Taiwan. Arthritis and
Rheumatism, 63, 352–358. doi:10.1002/art.30134
Cohen, S. B., Emery, P., Greenwald, M. W., Dougados, M., Furie, R. a, Genovese, M. C., …
Totoritis, M. C. (2006a). Rituximab for rheumatoid arthritis refractory to anti-tumor
necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebocontrolled, phase III trial evaluating primary efficacy and safety at twenty-four weeks.
Arthritis and Rheumatism, 54(9), 2793–806. doi:10.1002/art.22025
Cohen, S. B., Emery, P., Greenwald, M. W., Dougados, M., Furie, R. A., Genovese, M. C.,
… Totoritis, M. C. (2006b). Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebocontrolled, phase III trial evaluating primary efficacy and safety at twenty-four weeks.
Arthritis and Rheumatism, 54, 2793–2806. doi:10.1002/art.22025
Doyle, M. K., Rahman, M. U., Frederick, B., Birbara, C. a, de Vries, D., Toedter, G., …
Furst, D. E. (2013). Effects of subcutaneous and intravenous golimumab on
inflammatory biomarkers in patients with rheumatoid arthritis: results of a phase 1,
randomized, open-label trial. Rheumatology (Oxford, England), 52(7), 1214–9.
doi:10.1093/rheumatology/kes381
Emery, P. (2012). Optimizing outcomes in patients with rheumatoid arthritis and an
inadequate response to anti-TNF treatment. Rheumatology (Oxford, England), 51 Suppl
5, v22–30. doi:10.1093/rheumatology/kes115
Emery, P., Fleischmann, R., Filipowicz-Sosnowska, A., Schechtman, J., Szczepanski, L.,
Kavanaugh, A., … Shaw, T. M. (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 and
Rheumatism, 54(5), 1390–400. doi:10.1002/art.21778
Emery, P., Gottenberg, J. E., Rubbert-Roth, a, Sarzi-Puttini, P., Choquette, D., Martínez
Taboada, V. M., … Finckh, a. (2014). Rituximab versus an alternative TNF inhibitor in
patients with rheumatoid arthritis who failed to respond to a single previous TNF
inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study.
Annals of the Rheumatic Diseases. doi:10.1136/annrheumdis-2013-203993Haraoui, B., & Bykerk, V. (2007). Etanercept in the treatment of rheumatoid arthritis.
Therapeutics and Clinical Risk Management, 3(1), 99–105.
doi:10.2147/tcrm.2007.3.1.99
Kay, J., & Rahman, M. U. (2009). Golimumab : A novel human anti-TNF- α monoclonal
antibody for the treatment of rheumatoid arthritis , ankylosing spondylitis , and psoriatic
arthritis, 159–170.
Keyser, F. De. (2011). Choice of Biologic Therapy for Patients with Rheumatoid Arthritis:
The Infection Perspective. Current Rheumatology Reviews, 7(1), 77–87.
doi:10.2174/157339711794474620
Keystone, E. C., Genovese, M. C., Hall, S., Miranda, P. C., Bae, S.-C., Palmer, W., … Hsia,
E. C. (2013). Golimumab in patients with active rheumatoid arthritis despite
methotrexate therapy: results through 2 years of the GO-FORWARD study extension.
The Journal of Rheumatology, 40(7), 1097–103. doi:10.3899/jrheum.120584
Ma, X., & Xu, S. (2012). TNF Inhibitor Therapy for Rheumatoid Arthritis, 1(2), 1–7.
doi:10.4172/scientificreports.15
Mease, P. J. (2007). Adalimumab in the treatment of arthritis. Therapeutics and Clinical Risk
Management, 3(1), 133–148. doi:10.2147/tcrm.2007.3.1.133
Paulos, C. M., Varghese, B., Widmer, W. R., Breur, G. J., Vlashi, E., & Low, P. S. (2006).
Folate-targeted immunotherapy effectively treats established adjuvant and collageninduced arthritis. Arthritis Research & Therapy, 8(3), R77. doi:10.1186/ar1944
Piscaer, T. M., Müller, C., Mindt, T. L., Lubberts, E., Verhaar, J. a N., Krenning, E. P., …
Weinans, H. (2011). Imaging of activated macrophages in experimental osteoarthritis using folate-targeted animal single-photon-emission computed tomography/computed
tomography. Arthritis and Rheumatism, 63(7), 1898–907. doi:10.1002/art.30363
Prakken, B. J., Samodal, R., Le, T. D., Giannoni, F., Yung, G. P., Scavulli, J., … Albani, S.
(2004). Epitope-specific immunotherapy induces immune deviation of proinflammatory
T cells in rheumatoid arthritis. Proceedings of the National Academy of Sciences of the
United States of America, 101(12), 4228–33. doi:10.1073/pnas.0400061101
Rubbert-Roth, A. (2012). Assessing the safety of biologic agents in patients with rheumatoid
arthritis. Rheumatology (Oxford, England), 51 Suppl 5(March), v38–47.
doi:10.1093/rheumatology/kes114
Thalayasingam, N., & Isaacs, J. D. (2011). Anti-TNF therapy. Best Practice & Research.
Clinical Rheumatology, 25(4), 549–67. doi:10.1016/j.berh.2011.10.004
Van de Putte, L. B. a, Atkins, C., Malaise, M., Sany, J., Russell, a S., van Riel, P. L. C. M.,
… Kupper, H. (2004). Efficacy and safety of adalimumab as monotherapy in patients
with rheumatoid arthritis for whom previous disease modifying antirheumatic drug
treatment has failed. Annals of the Rheumatic Diseases, 63(5), 508–16.
doi:10.1136/ard.2003.013052
Van Vollenhoven, R. F. (2009). Treatment of rheumatoid arthritis: state of the art 2009.
Nature Reviews. Rheumatology, 5(10), 531–41. doi:10.1038/nrrheum.2009.182
Author(s) and co-author(s) jointly and severally represent and warrant that the Article is original with the author(s) and does not infringe any copyright or violate any other right of any third parties, and that the Article has not been published elsewhere. Author(s) agree to the terms that the IJRDO Journal will have the full right to remove the published article on any misconduct found in the published article.
