류마티스 관절염의 약물치료(II): 사용중인 생물학적 제제 및 개발중인 약제

Abstract

Disease-modifying antirheumatic drugs (DMARD) have been used to treat rheumatoid arthritis (RA). However, they have limited efficacy and a considerable adverse event profile. Excess production of soluble cytokines, including tumor necrosis factor (TNF), interleukin-1 (IL-1), and IL-6, appears to mediate the chronic inflammation associated with RA. Clinical trials with targeted anticytokine biologic agents, including anti-TNF alpha antibodies (adalimumab, infliximab, golimumab, cedolizumab), anti-IL-6 receptor antibodies (tocilizumab), and the soluble tumor necrosis factor-a receptor (etanercept), have shown remarkable efficacy in the treatment of RA. In addition, costimulatory blockade (abatacept) and B cell depletion (rituximab) have been employed as important adjunctive therapies in RA. Judicious use of these agents, considering their benefits and risks, would bring the greatest benefit to RA patients. The optimal conditions for the administration and indication of these drugs are under investigation. Signal transduction is another target of newly developing drugs. Because of the development of anti-TNF therapy and other biologics, there have been great advances in the treatment of RA.