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Anti-cytokine biologics 

Anti-cytokine biologics
Anti-cytokine biologics
Oxford Textbook of Rheumatology (4 edn)

Andrew J. K. Östör


Following the introduction of biologic disease-modifying agents into the therapeutic armoury against rheumatoid arthritis (RA) a dramatic shift has occurred in the natural history of the condition. Improvements have been seen not only in the signs and symptoms of disease but also in radiographic progression, functionality, quality of life, and productivity. Anti-cytokine biologics have been at the forefront of this management ’revolution’ as tumour necrosis factor (TNF) antagonists were the first to be trialled in this setting, leading to a profound alteration in the treatment paradigm. In addition to the five anti-TNF biologics (infliximab, etanercept, adalimumab, certolizumab, golimumab), IL-6 blockade with tocilizumab has also been shown to be effective in RA. Antagonism of IL-1 with anakinra, however, has not been as successful. In order to optimize outcomes anti-cytokine biologics are being used earlier in the management of RA. Trial data has shown that they work as well, if not better, in early disease, to achieve disease remission. Safety remains of paramount importance, particularly the increased risk of infection, which has been seen in clinical trials and in biologic registries. The side-effect profile is favourable overall, however. A number of novel anti-cytokine biologics are currently being trialled potentially paving the way for ’individualized’ therapy.

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