Rheumatoid arthritis treatment options - biological drug treatments
Definitions and PBS entry point
- bDMARDs = monoclonal antibodies / fusion proteins against a cytokine, cytokine receptor or cell-surface molecule
- tsDMARDs = small-molecule oral inhibitors of intracellular signalling (JAK inhibitors)
- Entry point in RA: failure of the csDMARD strategy (PBS: active disease despite >=2 DMARDs including MTX at adequate dose for >=6 months)
| Class | Agents | Target |
|---|---|---|
| TNF inhibitor | Infliximab, adalimumab, golimumab, certolizumab (monoclonals); etanercept (soluble receptor fusion) | TNF-alpha |
| IL-6 receptor | Tocilizumab, sarilumab | IL-6R |
| Co-stimulation | Abatacept (CTLA-4-Ig) | CD80/86 (B7) on APCs |
| Anti-CD20 | Rituximab | CD20 on B cells |
| JAK inhibitor | Tofacitinib (JAK1/3), baricitinib (JAK1/2), upadacitinib (JAK1) | JAK-STAT signalling |
| IL-1 | Anakinra | IL-1R (poor in RA; used in Still disease, gout, periodic fevers) |
- *Combine with methotrexate wherever possible* - greater efficacy, less immunogenicity
- Exceptions that work well as monotherapy: tocilizumab and JAK inhibitors
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