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This article is part of the supplement: Proceedings of the 8th Global Arthritis Research Network (GARN) Meeting and 1st Bio-Rheumatology International Congress (BRIC)

Oral presentation

Overview of biotherapy in rheumatoid arthritis (RA)

Tsutomu Takeuchi* and Hideto Kameda

  • * Corresponding author: Tsutomu Takeuchi

Author Affiliations

Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Shinjyuku,Tokyo, Japan

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Arthritis Research & Therapy 2012, 14(Suppl 1):O41  doi:10.1186/ar3596


The electronic version of this article is the complete one and can be found online at: http://arthritis-research.com/content/14/S1/O41


Published:9 February 2012

© 2012 Takeuchi and Kameda; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Oral presentation

Biological agents targeting a specific molecule provide an effective means for therapeutic management of rheumatoid arthritis (RA) due to their specificity and powerful functional capabilities, which has resulted in a paradigm shift in the treatment strategy of this disease. The dramatic improvement of the sign and symptoms of a patient with RA first came from the report with chimeric anti-TNF alpha monoclonal, infliximab in 1993. The observation was confirmed in the double-blind randomized controlled study comparing this biological agent and placebo in 1994. The first approved biologics for RA was TNF Receptor 1-Ig fusion protein, etanercept in the United States in 1998. Until now, nine biological agents are approved in RA worldwide. Revolutionary change of RA management with biological therapies obtained in western countries and Japan has been reviewed [1].

Atreatment strategy that uses tightly controlled dosesof administered biologics, targeting clinical remission or low disease activity, and followed by discontinuation of the biologics may be advantageous from botha health and economical point of view. This strategy is now being examinedin several clinical studies and trials in Japan for several biologics, including infliximab, etanercept, tocilizumab, and abatacept [1].

It is ideal to personalize medical treatment for individual RA patients by predicting efficacy and safety of a given biologic. In order to identify predictive factors, enormous amounts of efforts have put forth. Although several clinical variables have been associated with efficacy and safety, they are often unrealistic in clinical practice. We found that the baseline circulating TNF levels [2] and Fc gamma 3B polymorphism [3] are important predicting factors for response to infliximab in RA patients, and discuss the role of these markers in real world. Further clinical studies using biomarkers and molecular expression pattern [4,5] should provide a clue to find the appropriate predicting markers or even new therapeutic targets. In the near future, the information accumulated from these studies may allow selecting the best biological agents in individual patient.

References

  1. Takeuchi T, Kameda H: The Japanese experiences with biologic therapies for rheumatoid arthritis.

    Nat Rev Rheumatol 2010, 6:644-652. PubMed Abstract | Publisher Full Text OpenURL

  2. Takeuchi T, Miyasaka N, Tatsuki Y, Yano T, Yoshinari T, Abe T, Koike T: Baseline tumor necrosis factor alpha levels predict the necessity for dose escalation of infliximab therapy in patients with rheumatoid arthritis.

    Ann Rheum Dis 2011, 70:1208-15. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  3. Okuyama A, Nagasawa H, Suzuki K, Kameda H, Kondo H, Amano K, Takeuchi T: Fc gamma receptor IIIb polymorphism and usage of glucocorticoids at baseline are associated with infusion reactions to infliximab in patients with rheumatoid arthritis.

    Ann Rheum Dis 2011, 70:299-304. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  4. Sekiguchi N, Kawauchi S, Furuya T, Matsuda K, Ando S, Ogasawara M, Inaba N, Abe T, Ito S, Takeuchi T: Monitoring of cDNA microarray profile in peripheral blood during infliximab treatment of rheumatoid arthritis patients.

    Rheumatology 2008, 47:780-88. PubMed Abstract | Publisher Full Text OpenURL

  5. Tanino M, Matoba R, Nakamura S, Kameda H, Amano K, Okayama T, Nagasawa H, Suzuki K, Matsubara K, Takeuchi T: Prediction of efficacy of anti-TNF biologic agent, infliximab, for rheumatoid arthritis patients using a comprehensive transcriptome analysis of white blood cells.

    Biochem Biophys Res Comm 2009, 387:261-265. PubMed Abstract | Publisher Full Text OpenURL