title: What is the future of targeted therapy in rheumatology: biologics or small molecules?
abstract: BACKGROUND
  Until late in the 20th century, the therapy of rheumatic diseases relied on the use of drugs that had been developed through empirical approaches without detailed understanding of the molecular mechanisms involved. That approach changed with the introduction of biologic therapeutics at the end of the 20th century and by the recent development of small-molecule inhibitors of intracellular signal transduction pathways. Here we compare and discuss the advantages and disadvantages of those two groups of targeted anti-inflammatory therapeutics.
  
  
  CONCLUSIONS
  TNF-blocking biologic agents were introduced into the therapy of rheumatoid arthritis and other autoimmune and inflammatory diseases in the late 1990s. Further biologic agents targeting cytokine networks or specific lymphocyte subsets have since been added to the armamentarium of anti-rheumatic therapy. During the last few years, another wave of novel discoveries led to the development of a new class of small molecule anti-inflammatory compounds targeting intracellular signal transduction molecules, such as tyrosine kinases. In all those cases, the specific targets of the drugs are well defined and significant knowledge about their role in the disease pathomechanism is available, qualifying them for being targeted therapeutics for inflammatory rheumatic diseases. While both groups of targeted therapeutics offer significant clinical benefit, they clearly differ in several aspects, such as the localization of their targets, their route of administration and target specificity, as well as technical details such as manufacturing procedures and cost basis. In this debate paper, we compare the advantages and disadvantages of the two different approaches, aiming to shed light on the possible future of targeted therapies.
  
  
  CONCLUSIONS
  Biologic therapeutics and small-molecule inhibitors both have significant advantages and disadvantages in the therapy of rheumatic diseases. The future of targeted therapies is one of the most exciting questions of current rheumatology research and therapy.
authors.affiliation: Department of Physiology, Semmelweis University School of Medicine, 1094 Budapest, Hungary. mocsai.attila@med.semmelweis-univ.hu.
authors.forename: Attila
authors.initials: A
authors.lastname: Mócsai
authors.forename: László
authors.initials: L
authors.lastname: Kovács
authors.forename: Péter
authors.initials: P
authors.lastname: Gergely
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy; D001685:Biological Factors / Q000008:administration & dosage* / Q000737:chemistry; D016503:Drug Delivery Systems / Q000639:trends*; D005544:Forecasting; D006801:Humans; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy*; D012219:Rheumatology / Q000639:trends*
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D001685:Biological Factors