Biological therapy in the treatment of inflammatory rheumatic diseases

Naše razumijevanje patogeneze autoimunih bolesti raste iz dana u dan. U korak s novim spoznajama se kreće i razvoj terapije, koja se razvija kako bi ciljala specifične patogenetske puteve autoimunih bolesti. Od predstavljanja etanercepta krajem devedesetih godina prošlog stoljeća, razvila se nekolicina novih bioloških lijekova, uglavnom za terapiju reumatoidnog artiritisa, ali također psorijatičnog artritisa i ankilozantnog spondilitisa. Navedene kronične upalne reumatske bolesti imaju veliki zdravstveni i socijalni utjecaj, te znatno narušavaju kvalitetu života oboljelih. Većina trenutnih bioloških lijekova na različite načine cilja TNF-alfa (npr. etanercept, infliksimab, adalimumab, golimumab, i certolizumab pegol), IL-6 (tocilizumab), CTLA-4 (abatacept), i B stanice (rituksimab), pošto su oni ključni posrednici upalne kaskade. Nadalje, odnedavno su razvijene male molekule koje ciljaju komponente untarstanične signalizacije, poput tofacitiniba za Janus kinazu. Biološki lijekovi su indicirani po neuspjehu liječenja bolesti modificirajućim lijekovima. Veoma uspješno kontroliraju simptome reumatskih bolesti, te također usporavaju progresiju i induciraju remisiju. Trenutni dokazi sugeriraju da se povećani infekcijski rizik povezan s biološkom terapijom može prevenirati, ali se svakako mora uzeti u obzir prije početka liječenja. Biološka terapija je neosporno budućnost liječenja autoimunih bolesti, stoga je ulaganje u istraživanje i razvoj novih bioloških lijekova, te poboljšanje trenutnih terapijskih kombinacija zasigurno opravdano.Our understanding of autoimmune disease pathogenesis is improving on daily basis. As our knowledge expands, new treatment options are being developed that target specific pathogenic patterns of autoimmune diseases. Since the introduction of etanercept, in the late 90's, several new biologic agents were created, most of which were designed for treatment of RA, but also for treatment of psoriatic arthritis and ankylosing spondylitis. These are common chronic inflammatory joint diseases that have a major health care and social impact, and can severely affect patient’s quality of life. The majority of currently available biologic agents target TNF-alpha (for example etanercept, infliximab, adalimumab, golimumab and certolizumab pegol), IL-6 (tocilizumab), CTLA-4 (abatacept) and B-cells (rituximab) in different ways, since those are the key intermediaries in the cascade of inflammation. Recently, small molecules that target intracellular signal pathways were developed, for example tofacitinib that targets Janus kinase. Biologic agents are used as a treatment option after DMARD therapy has failed. They are very successful in controlling the symptoms of rheumatic diseases by slowing down progression of the disease and inducing remission. Current evidence suggests that the increased risk of infection associated with biological therapy can be prevented, but definitely has to be considered before starting the treatment with biological agents. Biological therapy is undoubtedly the future of autoimmune disease treatment therefore, investments into research of new biological agents or further development of existing ones, are completely justified