REVIEW - Newer biologic agents in the treatment of RA: do the benefits outweigh the risks?

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Drugs. 2009;69(15):2035-43. doi: 10.2165/11318290-000000000-00000.

Newer biological agents in the treatment of rheumatoid arthritis: do

the benefits outweigh the risks?

Nurmohamed MT.

Department of Rheumatology, VU University Medical Centre, Amsterdam,

The Netherlands.

Recently, three new biological agents, rituximab, abatacept and

tocilizumab, have become available for the treatment of rheumatoid

arthritis (RA) in patients with active disease, who have not responded

to at least one disease-modifying antirheumatic drug (DMARD).

Rituximab is an anti-CD20 monoclonal antibody, abatacept modulates

T-cell activation and tocilizumab is an interleukin-6 receptor

antagonist. Clinical studies with these agents have demonstrated that

they are effective in RA patients with moderate to active disease, who

have not responded to treatment with at least one DMARD and/or tumour

necrosis factor (TNF) inhibitor. Thus far, there is no convincing

evidence to show that one of these three new drugs has a superior

efficacy over the others or that they have other benefits compared

with the TNF inhibitors. The use of rituximab, instead of another TNF

inhibitor, might be an option in patients who have not responded to

TNF blockade. Abatacept could also be considered, but this has not yet

been formally tested. A practical advantage of tocilizumab is that it

may be administered as a first-line biological agent. Adverse events,

including (usually mild) infusion reactions, are common. There is a

small increased risk of serious infections that appears to be similar

to that with TNF inhibitors, although each drug may have its own

particular risk profile. Thus far, there is no convincing evidence

that the new biological agents are associated with an increased risk

of malignancies. However, the number of patient-years studied is still

rather limited and, hence, continuous postmarketing surveillance is

necessary. Adequate studies directly comparing new biological agents

with each other and with other biological agents, such as TNF

inhibitors, are not available. Hence, no firm conclusions regarding

the benefit-risk profile of these agents versus each other can be

reached. However, the benefit for a given new biological agent

currently appears to outweigh the risk for an individual RA patient

with active disease, despite earlier drug treatment.

PMID: 19791825

http://preview.ncbi.nlm.nih.gov/pubmed/19791825

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