Biologics are a relatively new class of drugs that have been used and studied for almost 20 years, and many new targeted biologics known as bDMARDs have emerged with the promise of not only providing better treatment for rheumatic diseases, but also the potential of having fewer side effects than conventional DMARDs.
These new biologics and targeted therapies can provide additional treatment options for rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients who have not responded to current therapies, said Jessica Farrell, PharmD, Associate Professor of Pharmacy Practice at the Albany College of Pharmacy and Health Sciences.
She will present the Tuesday morning ARHP concurrent session Pharmacotherapy: What’s New in Rheumatology.
“Because there are so many avenues and targeted therapies that are emerging, it’s very hard to keep up with all the new literature that is being published and all the new agents that are potentially coming to market,” Dr. Farrell said. “So I think it’s important for health care providers to know what is on the horizon and be able to have a general idea of what treatments might be options for their patients who have failed current available therapies.”
In RA, there has been some promising research on a new IL-6 inhibitor, sarilumab, a fully human anti–IL-6Ra monoclonal antibody that binds membrane-bound and soluble human IL-6R with high affinity. Dr. Farrell said that the MOBILITY Phase 3 clinical trial found sarilumab 150 mg and 200 mg groups, combined with methotrexate, to demonstrate statistically significant improvements as compared with placebo. Treatment groups also showed significant improvements in functional and radiographic outcomes.
In addition, a non-inferiority study published in August, working with patients with moderate to severe chronic plaque psoriasis, found tofacitinib to be non-inferior to etanercept. Dr. Farrell also said that ongoing Phase III studies are looking at tofacitinib’s efficacy in PsA and that researchers are studying modified release formulation of tofacitinib.
She said work has been done on applying IL-17 inhibitors in the treatment of both psoriasis and RA. The IL-17 inhibitor, secukinumab, has shown benefit in patients with PsA in the FUTURE trials.
Improvements observed with subcutaneous secukinumab 300 mg and 150 mg were sustained over one year of treatment in the majority of patients (64 percent for both doses). Moreover, ACR50 response rates were also sustained to one year in secukinumab 300 mg and 150 mg (44 percent and 39 percent, respectively.)
Some of today’s first-line biologics can cause serious adverse effects. Immunosuppression, for instance, can lead to serious infections. Dr. Farrell said the hope is that these new therapies can minimize those problems.
“Although infections are always going to be something we are concerned about, hopefully some of these newer agents — being more specific and more targeted — will have fewer adverse effects associated with them,” she said.
Dr. Farrell said it was great to see so many potential new therapies in the pipeline, especially for patients who don’t respond well to today’s standard therapies. It’s hard to know at this point whether any of these new agents are better than the ones we have, she said, “but the good thing is that we have more options.”
The complexity of the immune system offers a lot of different therapeutic targets, she said.
“Because our immune system is so smart,” Dr. Farrell said, “we know (patients) are not going to respond to the same drugs forever, so it is important we have other treatment options to target the disease state from different angles.”