Systemic rheumatic diseases: From biological agents to small molecules

Area of Science:

• Rheumatology
• Pharmacology
• Immunology

Background:

• Biologics and small oral molecules represent a paradigm shift in treating systemic rheumatic diseases.
• These innovative drugs target specific molecular or cellular pathways involved in disease pathogenesis.
• Current management recommendations are regularly updated to reflect advancements in pharmacologic treatment.

Purpose of the Study:

• To review the updated management recommendations for systemic rheumatic diseases, focusing on novel therapeutic agents.
• To outline treatment strategies for Rheumatoid Arthritis, Axial Spondyloarthritis, and Psoriatic Arthritis.
• To discuss the role of biosimilars in managing treatment costs and ensuring access to advanced therapies.

Main Methods:

• Review of institutional guidelines for Rheumatoid Arthritis, Axial Spondyloarthritis, and Psoriatic Arthritis.
• Analysis of treatment approaches including conventional therapies, biologics, and small oral molecules.
• Consideration of treatment strategies such as treat-to-target and management of comorbidities.

Main Results:

• Rheumatoid Arthritis guidelines incorporate TNF inhibitors, abatacept, rituximab, IL-6 inhibitors, and JAK inhibitors.
• Axial Spondyloarthritis management progresses from NSAIDs to local therapies or biologics (TNF or IL-17 inhibitors).
• Psoriatic Arthritis treatment involves NSAIDs, local steroids, conventional therapies, and advanced biologics or small molecules, with specific guidelines for complex cases.

Conclusions:

• Biologics and small oral molecules offer targeted treatment options for rheumatic diseases.
• Biosimilars are crucial for reducing therapy costs and increasing patient access.
• Adherence to scientific guidelines and patient-specific clinical conditions, alongside cost considerations, is essential for optimal treatment selection.