Systemic rheumatic diseases: From biological agents to small molecules

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Piercarlo Sarzi-Puttini, Angela Ceribelli, Daniela Marotto, Alberto Batticciotto, Fabiola AtzeniAbstractThe development of biologics and small oral molecules has recently changed the scenario of pharmacologic treatment of systemic rheumatic diseases and it has become a real revolution. These drugs have innovative mechanisms of action, based on the inhibition of specific molecular or cellular targets directly involved in disease pathogenesis.This new scenario has lead to a regular update of the management recommendations of several institututions, such as those for Rheumatoid Arthritis treatment that address the use of conventional and biologic therapies including TNFin (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, IL-6 inhibitors (tocilizumab and sarilumab), biosimilars and small oral molecules (the JAK inhibitors tofacitinib and baricitinib). Monotherapy, combination therapy, treatment strategies (such as treat-to-target) and the targets of sustained clinical remission or low disease activity are the final goal of the guidelines for rheumatic patients management. In another condition represented by Axial Spondyloarthritis guidelines suggest to start first with non-stroidal anti-inflammatory drugs to improve lifestyle and reduce spine inflammation, but if this is not achieved in 2–4 weeks it is important to consider the use of local therapies ...
Source: Autoimmunity Reviews - Category: Allergy & Immunology Source Type: research