Targeted and biological drugs in the treatment of inflammatory rheumatic diseases

Abstract

The aim of the review article is to provide an overview of biological and targeted drugs currently registered in the Czech Republic for the treatment of inflammatory rheumatic diseases. Specifically, the review deals with the treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). Five anti-TNF drugs as well as four biological drugs with a different mechanism of action (abatacept, rituximab, and two IL-6 inhibitors) are currently registered for the treatment of RA. In the past two years, Janus kinase (JAK) inhibitors have been introduced in the clinical management of RA, namely tofacitinib, baricitinib, upadacitinib, and filgotinib. They are small molecules of non-biological origin which enter the cell and inhibit signal transduction. Biological or targeted therapy of RA is indicated in the case of failure of conventional treatment and when there is at least moderate or high RA activity. Five anti-TNF drugs are indicated in the treatment of spondyloarthritides. They have been shown to be equally effective except for etanercept which is not effective for a coexisting inflammatory bowel disease. Recently, the IL-17 inhibitors secukinumab and ixekizumab have been introduced in the treatment of axial spondyloarthritis. Their efficacy on the locomotor system is similar to that of anti-TNF, but they are more effective in treating psoriasis. In the treatment of psoriatic arthritis, TNF inhibitors as well as IL-12/23 axis modulators and interleu¬kin-17 inhibitors have been introduced. Furthermore, targeted synthetic drugs are used in the treatment of PsA, namely the phosphodiesterase-4 inhibitor apremilast, whose efficacy is lower, and the newly introduced JAK1/3 inhibitor tofacitinib. The individual chapters are complemented by basic safety risks of these drugs and principles of treatment safety monitoring.