Abstract
Rheumatoid arthritis (RA) affects around 1.2% of the adult population. RA is one of the main reasons for work disability and premature retirement, thus substantially increasing social and economic burden. Biological disease-modifying antirheumatic drugs (bDMARDs) were shown to be an effective therapy especially in those rheumatoid arthritis (RA) patients, who did not adequately respond to conventional synthetic DMARD therapy. However, despite the proven efficacy, the high cost of the therapy resulted in limitation of the widespread use and unequal access to the care. The introduction of biosimilars, which are much cheaper relative to original drugs, may facilitate the achievement of the therapy by a much broader spectrum of patients. In this review we present the properties of original biologic agents based on cytokine-targeted (blockers of TNF, IL-6, IL-1, GM-CSF) and cell-targeted therapies (aimed to inhibit T cells and B cells properties) as well as biosimilars used in rheumatology. We also analyze the latest update of bDMARDs’ possible influence on DNA methylation, miRNA expression and histone modification in RA patients, what might be the important factors toward precise and personalized RA treatment. In addition, during the COVID-19 outbreak, we discuss the usage of biologicals in context of effective and safe COVID-19 treatment. Therefore, early diagnosing along with therapeutic intervention based on personalized drugs targeting disease-specific genes is still needed to relieve symptoms and to improve the quality of life of RA patients.
Highlights
Disease-modifying antirheumatic drugs (DMARDs) cover a group of otherwise unrelated drugs interfering with the disease process leading to rheumatoid arthritis (RA) [1]
It has been previously demonstrated that genetic factors including single nucleotide polymorphisms (SNPs) in proinflammatory cytokines such as TNF, IL-1β, and IL-6 or their downstream elements were associated with response to biologic therapy treatment in RA patients
Epigenetics is characterized by changes in gene expression that are not determined by changes in the DNA sequence and if dysregulated, it can result in the development of various pathological conditions, including RA
Summary
Disease-modifying antirheumatic drugs (DMARDs) cover a group of otherwise unrelated drugs interfering with the disease process leading to rheumatoid arthritis (RA) [1]. All available TNFi share similar probability on reaching remission/low disease activity, response rate (30% primary nonresponders), cardiovascular risk reduction, and potential to stop radiographic progression, recent data show that adalimumab seems to be most effective in geriatric patients, while etanercept is associated with lower risk of developing tuberculosis [24,25,26,27]. VOLTAIRE-RA study’s extension did not show any differences in effectiveness, nor side effects between ADA biosimilar and biooriginator in extended 2 years prospective observation after the end of original studies [59] Another trial showed that there were no differences in immunogenicity, efficacy or safety even after one or two drug switches between biosimilar and biooryginator [60].
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