Biologic Drugs for Rheumatoid Arthritis in the Context of Biosimilars, Genetics, Epigenetics and COVID-19 Treatment

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.

Management of Rheumatoid Arthritis: An Overview

“…However, due to its high mass it can be a good therapeutic option during lactation. The biosimilar products of golimumab are still in a preclinical phase [ 202 ].…”

“…It is a biological molecule that can be safely used during pregnancy due to its lack of placental transfer and it has been approved for the treatment of RA in pregnant women [ 203 ]. The biosimilar products of certolizumab are still in a preclinical phase [ 202 ].…”

“…According to the ADACTA study, tocilizumab therapy was found to be more effective than adalimumab monotherapy in terms of reducing signs and symptoms in RA patients with an inadequate response to MTX therapy [ 207 ]. The most common side effects reported in clinical trials are upper respiratory tract infections, nasopharyngitis, cellulitis, and high blood pressure [ 202 ].…”

Tuning Monocytes and Macrophages for Personalized Therapy and Diagnostic Challenge in Rheumatoid Arthritis

“…Another target associated with macrophages in the treatment of RA is IL-6. Numerous studies have demonstrated the key role of the pleiotropic cytokine IL-6 in RA and the very positive effects of its blocking [139]. In RA, there are six drugs that focus on binding to IL-6: tocilizumab (the first anti-IL-6 receptor antibody), sarilumab, olokizumab, clazakizumab, vobarilizumab and sirukumab.…”

Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era

“…While some physicians may be concerned about patient adherence to SC therapies, high adherence rates with SC anti-TNF agents have been reported in a Canadian analysis of patients with RA, AS, or PsA [ 124 ]. Combined with the IV formulation, CT-P13 SC may afford patients more control over their treatment [ 125 ], with increased flexibility and convenience [ 13 ]. In turn, this could improve adherence: a Spanish observational study in RA concluded that compliance could be increased with less complex regimens [ 126 ].…”