Advantages and disadvantages of targeted therapy in patients with rheumatoid arthritis

Abstract

With the recent understanding of the pathogenesis of rheumatoid arthritis at the cellular and molecular levels, as well as the rapid progress of biotechnology, targeted therapies have been developed and used since 2000. Starting with the development of biological products, which were early targeted therapeutics, small molecule inhibitors have recently been developed that target Janus kinase, a signaling molecule for intracellular inflammatory cytokines. The use of targeted therapies has dramatically improved the treatment outcomes and prognosis of rheumatoid arthritis. However, there is still concern around long-term safety of drugs and the rise in the economic burden on individuals and society due to the high price of biological products and Janus kinase inhibitors. To use those targeted therapeutics efficiently to ensure that suitable patients can fully benefit, both a multidisciplinary approach and the collaboration of experts are required. From the patient’s perspective, it is necessary to develop a system of patient’ education and to support shared decision-making between patients and physician. From the perspective of medical personnel, it is necessary to ensure the autonomy of experts. In addition, from a socio-economic viewpoint, it is necessary to adjust drug prices and review biosimilar utilization plans to reduce medical costs. The expanding use of these drugs among rheumatoid arthritis patients will eventually lead to greater social benefits by reducing disability among patients, facilitating their economic activity, and improving their quality of life. However, it is time to discuss their appropriate selection and safe long-term use with well-trained experts.