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  • Review Article
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Unresolved issues in biologic therapy for rheumatoid arthritis

Abstract

The advent of biologic therapies for the treatment of rheumatoid arthritis (RA) has radically changed this therapeutic area. The currently available biologic agents have been studied extensively as part of their development and also during their subsequent years of use in clinical practice; as a result, the knowledge base regarding these therapeutics is very large. Nonetheless, a number of important questions remain and some key issues are still incompletely understood. In this Review, I discuss a number of these unresolved issues, including: the correct placement of biologic therapies in the long-term evolution of the RA disease process, and the expectations associated with such use; comparisons of therapeutic strategies that include conventional as well as biologic agents; optimal dosing of biologic agents; the elusive goal of personalized therapy; and an appraisal of the real impact of biologic therapy on patients' lives. It is concluded that, despite these unresolved issues, important progress has been made and many additional advances in our understanding can be expected during the coming years.

Key Points

  • Biologic treatments have had a major impact on the therapy of rheumatoid arthritis (RA) but important issues remain regarding their most effective use

  • Use of biologic agents in the very early stages of RA has shown some promise but needs further study

  • Correct dosing of biologic agents needs to be explored in more detail

  • The possibility of maintaining the gains that are achieved with a biologic agent with reduced dosages and/or after complete withdrawal of the agent is the focus of ongoing studies

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Figure 1: Biologic agents approved for the treatment of rheumatoid arthritis.
Figure 2: The course of RA illustrated as a river.
Figure 3: Exploring alternative dosing of biologic agents: a stalemate situation.

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R. F. van Vollenhoven has acted as a consultant for and received honoria and grant/research support from Abbott, Bristol–Myers Squibb, Merck, Pfizer, Roche and UCB Pharma.

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van Vollenhoven, R. Unresolved issues in biologic therapy for rheumatoid arthritis. Nat Rev Rheumatol 7, 205–215 (2011). https://doi.org/10.1038/nrrheum.2011.22

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