Current and Emerging DMARDs for the Treatment of Rheumatoid Arthritis

Overview

Journal Open Access Rheumatol

Publisher Dove Medical Press

Specialty Rheumatology

Date 2021 Jun 9

PMID 34104009

Citations 7

Authors

Eduardo Mysler

Mariana Caubet

Ana Lizarraga

Affiliations

Soon will be listed here.

Abstract

Rheumatoid arthritis (RA) is the most prevalent form of inflammatory arthritis. It is a profoundly serious and severe disease that if it goes untreated could have severe consequences to the joints and health of the patient who carries this diagnosis. The treatment of RA has dramatically changed since the year 2000, with the discovery of the TNFis, then other biologics, and finally the JAKi. All these new medications with or without methotrexate in combination, tight control and treat to target have produced a revolution in the outcome of this disease. We reviewed and summarized the treatment options, and the most significant papers for each one of these new drugs. The reader could have a full picture with all the references of the recent publications. We also updated the biosimilar situation in RA, as well as the new drugs that will be coming to the market in the next 5 years.

Citing Articles

Long-Standing Untreated or Inadequately Treated Seropositive Rheumatoid Arthritis in the Golden Age of Disease-Modifying Antirheumatic Drugs.

Arcilla C, Kaeley G, Thway M Cureus. 2025; 17(2):e78474.

PMID: 40051928 PMC: 11883720. DOI: 10.7759/cureus.78474.

Citrullinated Autoantigen-Specific T and B Lymphocytes in Rheumatoid Arthritis: Focus on Follicular T Helper Cells and Expansion by Coculture.

Ammon T, Zeitrag J, Mayr V, Benedicic M, Holthoff H, Ungerer M ACR Open Rheumatol. 2025; 7(1):e11785.

PMID: 39846262 PMC: 11755120. DOI: 10.1002/acr2.11785.

Therapeutic potential of antibody-drug conjugates possessing bifunctional anti-inflammatory action in the pathogenies of rheumatoid arthritis.

Dixit T, Vaidya A, Ravindran S Arthritis Res Ther. 2024; 26(1):216.

PMID: 39695738 PMC: 11656801. DOI: 10.1186/s13075-024-03452-0.

Galangin: A Promising Flavonoid for the Treatment of Rheumatoid Arthritis-Mechanisms, Evidence, and Therapeutic Potential.

Khawaja G, El-Orfali Y, Shoujaa A, Abou Najem S Pharmaceuticals (Basel). 2024; 17(7).

PMID: 39065811 PMC: 11279697. DOI: 10.3390/ph17070963.

DNA Methylation Signatures of Response to Conventional Synthetic and Biologic Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis.

Wang S, Lewis M, Pitzalis C Biomedicines. 2023; 11(7).

PMID: 37509625 PMC: 10377185. DOI: 10.3390/biomedicines11071987.

References

Clowse M, Scheuerle A, Chambers C, Afzali A, Kimball A, Cush J . Pregnancy Outcomes After Exposure to Certolizumab Pegol: Updated Results From a Pharmacovigilance Safety Database. Arthritis Rheumatol. 2018; 70(9):1399-1407. PMC: 6174965. DOI: 10.1002/art.40508. View

St Clair E, van der Heijde D, Smolen J, Maini R, Bathon J, Emery P . Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum. 2004; 50(11):3432-43. DOI: 10.1002/art.20568. View

Dougados M, Kissel K, Sheeran T, Tak P, Conaghan P, Martin Mola E . Adding tocilizumab or switching to tocilizumab monotherapy in methotrexate inadequate responders: 24-week symptomatic and structural results of a 2-year randomised controlled strategy trial in rheumatoid arthritis (ACT-RAY). Ann Rheum Dis. 2012; 72(1):43-50. PMC: 3551223. DOI: 10.1136/annrheumdis-2011-201282. View

Smolen J, Keystone E, Emery P, Breedveld F, Betteridge N, Burmester G . Consensus statement on the use of rituximab in patients with rheumatoid arthritis. Ann Rheum Dis. 2006; 66(2):143-50. PMC: 1798500. DOI: 10.1136/ard.2006.061002. View

Smolen J, Breedveld F, Burmester G, Bykerk V, Dougados M, Emery P . Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2015; 75(1):3-15. PMC: 4717393. DOI: 10.1136/annrheumdis-2015-207524. View

Smolen J, Burmester G, Combe B, Curtis J, Hall S, Haraoui B . Head-to-head comparison of certolizumab pegol versus adalimumab in rheumatoid arthritis: 2-year efficacy and safety results from the randomised EXXELERATE study. Lancet. 2016; 388(10061):2763-2774. DOI: 10.1016/S0140-6736(16)31651-8. View

Bathon J, Martin R, Fleischmann R, Tesser J, Schiff M, Keystone E . A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med. 2000; 343(22):1586-93. DOI: 10.1056/NEJM200011303432201. View

Emery P, Fleischmann R, Strusberg I, Durez P, Nash P, Amante E . Efficacy and Safety of Subcutaneous Golimumab in Methotrexate-Naive Patients With Rheumatoid Arthritis: Five-Year Results of a Randomized Clinical Trial. Arthritis Care Res (Hoboken). 2015; 68(6):744-52. PMC: 5089605. DOI: 10.1002/acr.22759. View

Dougados M, van der Heijde D, Chen Y, Greenwald M, Drescher E, Liu J . Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: results from the RA-BUILD study. Ann Rheum Dis. 2016; 76(1):88-95. PMC: 5264214. DOI: 10.1136/annrheumdis-2016-210094. View

10.

van Vollenhoven R, Fleischmann R, Cohen S, Lee E, Garcia Meijide J, Wagner S . Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. N Engl J Med. 2012; 367(6):508-19. DOI: 10.1056/NEJMoa1112072. View

11.

Gabay C, Emery P, van Vollenhoven R, Dikranian A, Alten R, Pavelka K . Tocilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. Lancet. 2013; 381(9877):1541-50. DOI: 10.1016/S0140-6736(13)60250-0. View

12.

Schiff M, Keiserman M, Codding C, Songcharoen S, Berman A, Nayiager S . Efficacy and safety of abatacept or infliximab vs placebo in ATTEST: a phase III, multi-centre, randomised, double-blind, placebo-controlled study in patients with rheumatoid arthritis and an inadequate response to methotrexate. Ann Rheum Dis. 2007; 67(8):1096-103. PMC: 2564802. DOI: 10.1136/ard.2007.080002. View

13.

Fleischmann R, Kremer J, Cush J, Schulze-Koops H, Connell C, Bradley J . Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. N Engl J Med. 2012; 367(6):495-507. DOI: 10.1056/NEJMoa1109071. View

14.

Burmester G, Kremer J, Van den Bosch F, Kivitz A, Bessette L, Li Y . Safety and efficacy of upadacitinib in patients with rheumatoid arthritis and inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs (SELECT-NEXT): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2018; 391(10139):2503-2512. DOI: 10.1016/S0140-6736(18)31115-2. View

15.

Espie P, He Y, Koo P, Sickert D, Dupuy C, Chokote E . First-in-human clinical trial to assess pharmacokinetics, pharmacodynamics, safety, and tolerability of iscalimab, an anti-CD40 monoclonal antibody. Am J Transplant. 2019; 20(2):463-473. DOI: 10.1111/ajt.15661. View

16.

Michaud T, Rho Y, Shamliyan T, M Kuntz K, Choi H . The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med. 2014; 127(12):1208-32. DOI: 10.1016/j.amjmed.2014.06.012. View

17.

Hernandez-Cruz B, Garcia-Arias M, Ariza Ariza R, Martin Mola E . [Rituximab in rheumatoid arthritis: a systematic review of efficacy and safety]. Reumatol Clin. 2011; 7(5):314-22. DOI: 10.1016/j.reuma.2011.03.004. View

18.

Genovese M, Fleischmann R, Combe B, Hall S, Rubbert-Roth A, Zhang Y . Safety and efficacy of upadacitinib in patients with active rheumatoid arthritis refractory to biologic disease-modifying anti-rheumatic drugs (SELECT-BEYOND): a double-blind, randomised controlled phase 3 trial. Lancet. 2018; 391(10139):2513-2524. DOI: 10.1016/S0140-6736(18)31116-4. View

19.

Fleischmann R, Yocum D . Does safety make a difference in selecting the right TNF antagonist?. Arthritis Res Ther. 2004; 6 Suppl 2:S12-8. PMC: 2833460. DOI: 10.1186/ar995. View

20.

Lee E, Fleischmann R, Hall S, Wilkinson B, Bradley J, Gruben D . Tofacitinib versus methotrexate in rheumatoid arthritis. N Engl J Med. 2014; 370(25):2377-86. DOI: 10.1056/NEJMoa1310476. View