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Publication Detail
TUMOUR NECROSIS FACTOR INHIBITORS USED IN THE TREATMENT OF RHEUMATOID ARTHRITIS: EVIDENCE OF SAFETY, EFFICACY AND HEALTH IMPLICATION
  • Publication Type:
    Chapter
  • Authors:
    Bechman K, Attipoe L, Ciurtin C
  • Publisher:
    NOVA SCIENCE PUBLISHERS, INC
  • Publication date:
    01/03/2017
  • Place of publication:
    New York
  • Chapter number:
    Chapter 9
  • Editors:
    Ciurtin C,Isenberg D
  • Book title:
    Biologics in Rheumatology: New Developments, Clinical Uses and Health Implication
  • Keywords:
    rheumatoid arthritis, biologic treatment
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune condition characterised by inflammation and destruction of synovial joints. The pathogenesis of inflammation is underpinned by interaction and activation of immune cells with the release of inflammatory cytokines such as tumour necrosis factor (TNF) and interleukins. These mechanisms of disease pathogenesis were targeted by specific drugs in the form of monoclonal antibodies (mAb) or soluble receptors. The advent of biological disease modifying therapies (bDMARDs) has revolutionised the management of RA. These agents dramatically reduce synovial inflammation, halt the progression of radiographic joint damage, and improve functional ability and health related quality of life outcomes. This has a positive impact on the socioeconomic burden of RA. This chapter reviews the pathogenesis of RA and evidence behind the use of TNF inhibitors licensed for RA treatment. We focus on clinical efficacy, safety profile and cost-effectiveness of infliximab, etanercept, adalimumab, certolizumab, golimumab. Additionally, we discuss national and international recommendations for the clinical use of TNF inhibitors, whith further consideration of the financial implications. Examples of clinical randomised controlled trials (RCTs) which proved the efficacy of different TNF inhibitors in RA treatment are also included in this chapter. The use of TNF inhibitor biosimilars will be discussed in chapter 11.
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