Editorial: Biological drugs and biosimilars in autoimmune diseases

Abstract

The usage of biological drugs in autoimmune diseases treatment has significantly changed the clinical disease course especially for patients with particularly complicated or poor response to the treatment, demonstrating the ability to inhibit disease progression. Therefore, nowadays, biologics represent an increasing proportion of total pharmaceutical expenses despite differences in standard of routine care and high prices (Reardon, 2020). The articles presented in the Research Topic highlight the broad area of this subject. In this Research Topic, three reviews, a case report, a research report and an original research articles were published.It has been over 20 years since the first clinical trials of anti-TNF alpha therapy (Elliott et al., 2008). Currently available biological drugs for clinical use in rheumatology are adalimumab, golimumab, infliximab, certolizumab, and etanercept. Adalimumab and golimumab are fully human monoclonal antibodies; infliximab is a chimeric monoclonal antibody with a murine variable region; certolizumab is a humanized Fab fragment conjugated with polyethylene glycol, while etanercept is a fusion protein of two TNF2 receptor extracellular domains and the Fc fragment of human immunoglobulin. Since then, anti-TNF therapy has found applications in various autoimmune diseases. Some of these are very rare, such as Behçet's disease (BD). A systematic review of controlled trials of anti-TNF therapy compared with conventional therapy was presented by Zhou et al.The authors investigated the efficacy and safety of anti-TNF therapy and summarized it in relation to the available therapeutic options. According to the authors, anti-TNF therapy reduces the relapses of uveitis in patients with BD in comparison with the traditional immunosuppressant (csDMARDs) therapy. This finding has significant implications for the protection against significant and permanent vision impairment or blindness. However, it has to be taken into consideration, that BD is a heterogeneous disease and presents different subtypes, such as Behçet's uveitis, intestinal BD, neurological-BD, and vascular-BD. Moreover, Zhou et al. found that both IFNα-2α and infliximab therapy (anti-TNF agent) were effective in inducing uveitis remission in patients with BD and that adalimumab and infliximab provided similar types of trends and qualitative conclusions in two studies on Behçet's uveitis.