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Joint Bone Spine
Volume 71, n° 6
pages 470-474 (novembre 2004)
Doi : 10.1016/j.jbspin.2004.07.008
Received : 13 July 2004 ;  accepted : 13 July 2004
Emerging biological therapies in rheumatoid arthritis

Xavier Mariette
Rheumatology Department, Inserm EMI 109, Bicêtre Teaching Hospital, Paris-Sud University, Le Kremlin Bicêtre, France 

*Corresponding author. Service de Rhumatologie, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France. Tel.: +33-01-45-21-37-58; fax : +33-01-45-21-37-57.

The introduction of TNF⍺ inhibitors has radically changed the management of patients with refractory rheumatoid arthritis (RA) or spondyloarthropathy. However, among patients with RA unresponsive to methotrexate, only two-thirds respond to TNF⍺ inhibitors. Fortunately, more than 5 years after infliximab was introduced on the market, preliminary evidence that emerging biological agents are effective is beginning to accumulate, generating new hope for patients who fail to respond to TNF⍺ inhibitors. These novel biological therapies grew out of original pathophysiological hypotheses, a fact that vividly illustrates the importance of basic pathophysiological research for developing new medications. This review provides detailed information on three biological therapies whose efficacy in RA was demonstrated in recently published randomized placebo-controlled trials: a monoclonal antibody to the IL-6 receptor (MRA), CTLA4-Ig (abatacept), and a monoclonal B-cell-specific antibody to CD20 (rituximab). Good risk/benefit ratios seem to be achieved with MRA alone or with abatacept or rituximab combined with methotrexate. However, as yet, no radiographic data are available for these treatments. One of the challenges for the future is to identify ingenious combinations of biological therapies capable of improving the quality and duration of responses without exacerbating side effects.

The full text of this article is available in PDF format.

Keywords : Biological therapies, MRA, Abatacept, Rituximab, Education

© 2004  Elsevier SAS. All Rights Reserved.