New Treatments for Rheumatoid arthritis

Researchers are constantly looking for new treatments to better manage Rheumatoid arthritis. Rheumatoid arthritis (RA) is an autoimmune disease well-recognized for affecting the joints of the hands, but it may affect many other organs like your heart, lungs, or eyes. Based on recent data, around 20 million people are living with Rheumatoid Arthritis, with more than 1 million newly diagnosed cases every year. 

What is Rheumatoid arthritis treatment?

First, you must know there isn’t a cure for Rheumatoid Arthritis. The current treatments can alleviate symptoms, delay joint damage, decrease joint inflammation, and help patients live active lives. The medicines available for RA are often divided into two categories:  Disease-modifying anti-rheumatic drugs (DMARDs) and biologics.

Disease-modifying anti-rheumatic drugs (DMARDs)

The most commonly used  Disease-modifying anti-rheumatic drugs (DMARDs) are: 

These drugs represent the first line of therapy and can be tried alone or in combination. Most patients with RA can get relief from their symptoms just by using these drugs. Some patients do not respond well or tolerate these medications due to severe side effects.

For example, methotrexate can cause abdominal pain, nausea, and severe fatigue. Sulfasalazine may cause anemia and low white blood cells. Hydroxychloroquine may affect the skin, increase photosensitivity, or can be contraindicated for patients with eye complications. For these patients, it is better to try other types of medication like biologics. 

Biologics

Biologics are newer classes of medications that will target different molecules in your body that are causing inflammation.

Many classes of biologics are named based on the type of molecule they try to block and decrease inflammation. They are powerful medications.

Here are the most common classes of biologics used these days

  1. TNF- alpha inhibitors 
  2. IL-6 inhibitors
  3. Abatacept 
  4. Jak Inhibitors

TNF-alpha inhibitors, such as Humira, Etanercept, Infliximab, and Golimumab, are great options for patients that fail DMARDs therapy. They can help stop inflammation and decrease disease activity. But, despite their beneficial properties, up to 40% of patients don’t respond appropriately to treatment. 

IL- 6 inhibitors, like Sarilumab and Tocilizumab, are approved for RA treatment in many countries, including the U.S. and Europe. They are biological medications that can treat moderate to severe RA. 

Abatacept is a biological drug often recommended for treating moderate to severe RA.

All these medications are injectables and can be administered as intravenous therapy or self-administered.  

Combination therapy

If DMARDs don’t improve the symptoms,  your doctor might suggest adding a biological medication.

For example, many patients can be on methotrexate and a biological medication (e.g Humira, Enbrel) simultaneously.

Combining the medications can have better odds of easing the symptoms and putting the condition into remission than relying on a drug alone.  

Biological medications can sometimes be seen as a foreign protein, and your body will try to neutralize that by forming “neutralizing antibodies’ ‘.

Adding methotrexate as a combination therapy to biologics can prevent antibodies formations and prolong the effect of that medication.

What are the new treatments for Rheumatoid arthritis?

Despite multiple classes of medications available for RA patients, some patients do not respond to these, or they respond just partially. That is why researchers are constantly trying to find newer therapies that will prevent joint damage, joint deformities, and other organ complications and to help patients to live a better life. 

Newer therapies are available these days, and others are emerging soon.

Here will present the newest medications available or in trials for RA patients:

Jak- inhibitors like (tofacitinib/ Xeljanz, RINVOQ/ upadacitinib, baricitinib/olumiant) have been approved in the last 5 years. The advantage is that they are pills and can be taken daily by patients. This is very convenient for many patients that do fear injections.  JAK inhibitors are FDA-approved for treating moderate to severe RA, especially in patients that fail DMARDs or TNF inhibitors.

Peficitinib (Smyraf) – This is another new JAK inhibitor approved in 2019 in Japan and is currently being evaluated in other countries (Korea, Taiwan, China). It is not approved yet in the USA.  It demonstrated safety and efficacy in RA treatment in controlled, randomized trials.

Filgotinib (Jyseleca) is a novel JAK inhibitor approved in 2020. Filgotinib is available in Europe and Japan but not in the United States. The medication can help decrease RA symptoms and limit joint damage and can be used alone or in combination with methotrexate.

Olokizumab (OKZ) – This is a new IL-6 inhibitor that was approved in 2020. Treatment with  olokizumab OKZ can significantly improve RA symptoms and physical function. In a recent phase 3 trial, combination therapy of olokizumab with methotrexate treatment was superior to placebo. But large-scale studies are necessary to determine the safety and efficacy of Olokizumab in treating RA patients. 

These are some of the most promising treatments for Rheumatoid arthritis. Although they can offer numerous beneficial properties, they can also cause side effects. It is essential to consult with a rheumatologist specialist when using any of these medications.

This is an educational article that aims to broaden your knowledge, but it does not offer you medical advice. If you have an autoimmune disease, like rheumatoid or psoriatic arthritis,  and you need help, you are welcome to check out our practice and get the help that you need when you need it the most. Rheumatologist OnCall is a telemedicine rheumatology practice that broadens access to a specialist in a very short time, when you need it the most, and breaks geographical barriers. Check out the states where we are licensed to see patients in the US and reach out to us if needed. We are happy to serve you.

  • Diana Girnita, MD, PhD, FACR

    Dr. Girnita is a physician-scientist double-board certified in rheumatology and internal medicine, trained at Harvard, with a PhD in immunology. She conducted award-winning immunology research and received the "Top Doc in Cincinnati" award before launching her direct-care/direct-pay Rheumatologist OnCall practice.

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