Chemical Medicines and Biopharmaceuticals in Rheumatoid Arthritis
DOI:
https://doi.org/10.54097/yapz3r75Keywords:
Rheumatoid arthritis, disease-modifying anti-rheumatic drugs, synthetic DMARDs, biologic DMARDs.Abstract
Rheumatoid arthritis is a disease caused by autoimmunity that results from a series of almost lifelong processes. Over decades, researchers have studied its cause and risk factors and many types of drugs for treating RA have been developed and approved. This article provides a comparative analysis of chemically synthesized disease-modifying anti-rheumatic drugs (sDMARDs) and biologic DMARDs (bDMARDs) in the treatment of rheumatoid arthritis (RA). While both aim to alleviate inflammation and prevent joint damage, their mechanisms of action differ significantly. sDMARDs broadly suppress immune cell activity, whereas bDMARDs target specific cytokines or pathways with higher selectivity. Clinical studies indicate that bDMARDs generally offer a faster onset of action, but long-term efficacy is comparable to sDMARD-based therapies. Safety profiles also diverge, with sDMARDs posing greater risks of organ toxicity, particularly hepatotoxicity, while bDMARDs increase susceptibility to infections and potential malignancies. Economic evaluations highlight the lower cost and higher accessibility of sDMARDs, solidifying their role as first-line treatments, despite the clinical advantages of bDMARDs and faster response rate.
Downloads
References
[1] Weyand, C.M., Goronzy, J.J. The immunology of rheumatoid arthritis. Nat Immunol 22, 10–18 (2021). https://doi.org/10.1038/s41590-020-00816-x DOI: https://doi.org/10.1038/s41590-020-00816-x
[2] Sugiyama, D., Nishimura, K., Tamaki, K., Tsuji, G., Nakazawa, T., Morinobu, A., & Kumagai, S. (2010). Impact of smoking as a risk factor for developing rheumatoid arthritis: A meta-analysis of observational studies. Annals of the Rheumatic Diseases, 69(1), 70–81. https://doi.org/10.1136/ard.2008.096487 DOI: https://doi.org/10.1136/ard.2008.096487
[3] Frisell, T., Saevarsdottir, S. & Askling, J. Family history of rheumatoid arthritis: an old concept with new developments. Nat Rev Rheumatol 12, 335–343 (2016). https://doi.org/10.1038/nrrheum.2016.52 DOI: https://doi.org/10.1038/nrrheum.2016.52
[4] Shapira, Y., Agmon-Levin, N. & Shoenfeld, Y. Geoepidemiology of autoimmune rheumatic diseases. Nat Rev Rheumatol 6, 468–476 (2010). https://doi.org/10.1038/nrrheum.2010.86 DOI: https://doi.org/10.1038/nrrheum.2010.86
[5] Finckh, A., Gilbert, B., Hodkinson, B., Bae, S.-C., Thomas, R., Deane, K. D., Alpizar-Rodriguez, D., & Lauper, K. (2022). Global epidemiology of rheumatoid arthritis. Nature Reviews Rheumatology, 18(10), 591–602. https://doi.org/10.1038/s41584-022-00827-y DOI: https://doi.org/10.1038/s41584-022-00827-y
[6] Friedman, B., & Cronstein, B. (2019). Methotrexate mechanism in treatment of rheumatoid arthritis. Joint Bone Spine, 86(3), 301–307. https://doi.org/https://doi.org/10.1016/j.jbspin.2018.07.004 DOI: https://doi.org/10.1016/j.jbspin.2018.07.004
[7] Bryan, M. C., & Rajapaksa, N. S. (2018). Kinase Inhibitors for the Treatment of Immunological Disorders: Recent Advances. Journal of Medicinal Chemistry, 61(20), 9030–9058. https://doi.org/10.1021/acs.jmedchem.8b00667 DOI: https://doi.org/10.1021/acs.jmedchem.8b00667
[8] Jang, D.-i., Lee, A.-H., Shin, H.-Y., Song, H.-R., Park, J.-H., Kang, T.-B., Lee, S.-R., & Yang, S.-H. (2021). The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and Current TNF-α Inhibitors in Therapeutics. International Journal of Molecular Sciences, 22(5), 2719. https://doi.org/10.3390/ijms22052719 DOI: https://doi.org/10.3390/ijms22052719
[9] Rheumatoid Arthritis Treatment Options | Johns Hopkins Arthritis Center. (n.d.). Retrieved August 26, 2025, from https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/#etanercept
[10] Scott, D. L., Ibrahim, F., Farewell, V., Go’Keeffe, A., Walker, D., Kelly, C., Birrell, F., Chakravarty, K., Maddison, P., Heslin, M., Patel, A., & Kingsley, G. H. (2015). Tumour necrosis factor inhibitors versus combination intensive therapy with conventional disease modifying anti-rheumatic drugs in established rheumatoid arthritis: TACIT non-inferiority randomised controlled trial. BMJ, 350. https://doi.org/10.1136/BMJ.H1046 DOI: https://doi.org/10.1136/bmj.h1046
[11] Preet Singh, Y., Aggarwal, A., Misra, R. et al. Low-dose methotrexate-induced pancytopenia. Clin Rheumatol 26, 84–87 (2007). https://doi.org/10.1007/s10067-006-0301-7 DOI: https://doi.org/10.1007/s10067-006-0301-7
[12] Ruderman, E. M. (2012). Overview of safety of non-biologic and biologic DMARDs. Rheumatology, 51(suppl_6), vi37–vi43. https://doi.org/10.1093/rheumatology/kes283 DOI: https://doi.org/10.1093/rheumatology/kes283
[13] de La Forest Divonne, M., Gottenberg, J. E., & Salliot, C. (2017). Safety of biologic DMARDs in RA patients in real life: A systematic literature review and meta-analyses of biologic registers. Joint Bone Spine, 84(2), 133–140. https://doi.org/https://doi.org/10.1016/j.jbspin.2016.02.028 DOI: https://doi.org/10.1016/j.jbspin.2016.02.028
[14] Mackey, A. C., Green, L., Leptak, C., & Avigan, M. (2009). Hepatosplenic T Cell Lymphoma Associated with Infliximab Use in Young Patients Treated for Inflammatory Bowel Disease: Update. Journal of Pediatric Gastroenterology and Nutrition, 48(3), 386–388. https://doi.org/https://doi.org/10.1097/MPG.0b013e3181957a11 DOI: https://doi.org/10.1097/MPG.0b013e3181957a11
[15] Joensuu, J. T., Aaltonen, K. J., Aronen, P., Sokka, T., Puolakka, K., Tuompo, R., Korpela, M., Vasala, M., Ilva, K., Nordström, D., & Blom, M. (2016). Cost-effectiveness of biologic compared with conventional synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis: a Register study. Rheumatology, 55(10), 1803–1811. https://doi.org/10.1093/rheumatology/kew264 DOI: https://doi.org/10.1093/rheumatology/kew264
[16] Chen D-Y, Yu F, Tuan L-W and Tang C-H (2019) Comparison of Healthcare Utilization and Costs Between RA Patients Receiving Biological and Conventional Synthetic DMARDs: A Nationwide Population-Based Cohort Study in Taiwan. Front. Pharmacol. 10:1214. doi: 10.3389/fphar.2019.01214 DOI: https://doi.org/10.3389/fphar.2019.01214
[17] Lee, Y.H., Song, G.G. All-cause and cause-specific mortality in rheumatoid arthritis: a meta-analysis. Z Rheumatol 83 (Suppl 3), 314–320 (2024). https://doi.org/10.1007/s00393-024-01538-3 DOI: https://doi.org/10.1007/s00393-024-01538-3
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Academic Journal of Science and Technology
This work is licensed under a Creative Commons Attribution 4.0 International License.
