Biological drug treatments for rheumatoid arthritis – an update

This study examined data from a number of recent studies to assess biological drug treatment for rheumatoid arthritis (RA). The authors concluded that the results confirmed the effectiveness of biological drugs in treating RA.

Disease-modifying anti-rheumatic drugs (DMARDs) is a category of drugs defined by their use in rheumatoid arthritis (RA) to slow down disease progression. Methotrexate (Rheumatrex) is a commonly prescribed type of DMARD. Some DMARDS are biological drugs. These target specific molecules involved in the processes of inflammation and joint damage. For example, TNF alpha inhibitors, such as adalimumab (Humira), block a protein called tumour necrosis factor known to contribute to inflammation in RA. Other biological drugs have different targets in the body. Patients who do not respond to one type of biological drug may therefore respond to another type of biological drug. Studies on the effectiveness of biological drugs are ongoing.

The authors reviewed data from a number of recent studies that looked at treatment of RA with biological drugs.

The authors compared the effectiveness of biological drugs on their own to a combination with a conventional DMARD. They concluded that biological drugs were more effective when given in combination with a DMARD than when administered alone. This was particularly pronounced in patients who had never taken DMARDs or who had been unresponsive to DMARDs. Patients who had never taken methotrexate showed the best treatment response with the combination of a biological drug and methotrexate.

The authors also looked at different treatment strategies for RA. Treat-to-target is a strategy where physicians treat patients with high doses of drugs with the aim of achieving remission. Trials that looked at different treatment strategies concluded that increasing treatment until remission is achieved is an effective strategy.

A number of trials assessed the outcomes of reducing or stopping biological drug treatment once disease activity was significantly reduced. These trials found that patients who stopped their treatment after disease activity was lowered were less likely to maintain this improvement than those who continued treatment. However, these trials also showed that reducing dosage by up to 50% and/or less frequent treatment was just as effective as continuing with a full dose.

Finally, the authors looked at trials on new biological drugs and biosimilars. Biosimilars are generic versions of commercial biological DMARDs. These trials confirmed the effectiveness of biological drugs with a new target in the body called interleukin 6. Effective biosimilars for adalimumab, etanercept (Enbrel), infliximab (Remicade), and rituximab (Rituxan) were also identified.

The authors concluded that these trials confirmed the effectiveness of biological drugs in treating rheumatoid arthritis. 

Some of the authors have affiliations with the companies that make drugs assessed in this study.

Consult with your physician about treatments that are currently available for rheumatoid arthritis.