New therapies in the management of rheumatoid arthritis

Abstract

The therapeutic landscape in the management of rheumatoid arthritis (RA) has witnessed significant changes over the past decade. The ambition to improve outcomes further, minimize safety concerns and provide more convenient means of administration are all factors that continue to drive continued drug development. This review summarizes novel therapies that have been most recently under investigation. More refined drug technology has seen the development of subcutaneous forms of existing therapies (abatacept, tocilizumab), as well as newer-generation monoclonal antibodies (e.g. B-cell-depleting agents, ocrelizumab and ofatumumab and the TNF-inhibitors certolizumab and golimumab). Alternative methods of targeting critical pathways, for example Blys inhibition (atacicept) and IL-6 as opposed to IL-6 receptor antagonism, have also been evaluated. Finally, small molecules are receiving increasing attention, with some of the protein kinases inhibitors particularly promising. The new emerging therapies for the management of RA illustrate much diversity, in terms of both drug technology as well as the immunological target. Although not all may succeed in reaching the market, important insights can still be gained. Challenging and exciting times lie ahead as these new technologies are embraced and efforts are made to determine how best to implement in practice.