title: Biologic agents for rheumatoid arthritis: can we hypothesize new strategies of treatment?
abstract: Rheumatoid arthritis is a complex multifactorial disease, whose pathogenesis has not been fully elucidated. Biologic agents have revolutionized RA treatment, but a significant percentage of patients does not obtain an adequate response to the therapy. Most of the biologic agents do better if combined with conventional immunosuppressive DMARDs and they show a similar efficacy profile: most of the responders achieve the minimum desirable level of response (ACR20) and only few patients obtain a worthwhile clinical improvement (ACR70 or better). We need to identify new strategies of treatment, able to comply the non satisfied needs of RA patients. Taking inspiration from other medical fields, we could hypothesize a combined regimen in which biologic agents are administered simultaneously at a low or ultra-low dosage, targeting several pathogenetic mechanisms but avoiding important side effects. Alternatively it should be useful to identify rapid succession regimens in which biologic drugs are taken according to an established sequence. Research in this field is obviously not encouraged by pharmaceutical industries, but our efforts should be driven in this direction. According to these observations, adequate clinical trials should be designed to search for appropriate drugs associations and dosages.
authors: Unit of Rheumatology, S. Pietro FBF Hospital, Research Center S. Pietro, Via Cassia 600, 00189 Rome, Italy. Electronic address: migliore.alberto60@gmail.com.
authors: Alberto
authors: A
authors: Migliore
authors: Unit of Rheumatology, S. Pietro FBF Hospital, Research Center S. Pietro, Via Cassia 600, 00189 Rome, Italy.
authors: Eleonora
authors: E
authors: Ballanti
authors: Division of Clinical Immunology and Rheumatology, II School of Medicine, S. Andrea University Hospital, "Sapienza" University of Rome, via di Grottarossa 1035, Rome, Italy.
authors: Bruno
authors: B
authors: Laganà
authors: Unit of Rheumatology, Regina Apostolorum Hospital, Via San Francesco D'Assisi 50, 00041 Albano Laziale, Rome, Italy.
authors: Luis Severino
authors: LS
authors: Martin
authors: Centre for Osteoporosis and Instrumental Diagnosis of Bone and Articular Diseases, Institute of Rheumatology, University of Siena, viale Bracci, 53100 Siena, Italy.
authors: Bruno
authors: B
authors: Frediani
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000379:methods*; D006801:Humans; D008954:Models, Biological; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors