Genetically engineered drugs for rheumatoid arthritis

Basic drugs are used in all patients with rheumatoid arthritis, if they have no contraindications. They relate to slow-acting agents. An important condition for successful therapy is an early appointment. The action is aimed at preventing deformation of the limbs, maintaining motor function.

The properties of the drugs include:

  1. Suppression of active proliferation of cells of the immune system.
  2. Persistence of clinical effect.
  3. Prevention of bone erosion in a damaged joint.
  4. Elongation of clinical remission of rheumatoid arthritis.

Medicines have different mechanisms of action and reception features, have a conditional division into the first and second row.

First-line drugs have the best ratio of effect and minimum unwanted actions. In numerous studies of these drugs, reliable suppression of the signs of the disease and the prevention of deforming processes in the joint have been proven.

The first row of basic medicines includes:

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Features of the appointment and use of methotrexate

Methotrexate is the gold standard for rheumatoid arthritis. The weekly dose averages 20-30 milligrams, but is selected separately for each patient. Reception is recommended to start with small doses of 2,5-5 mg per week, followed by their increase.

Methotrexate regimen: every week for 2 days inside, dividing the dose into three doses (with an interval of eight hours). If gastrointestinal upsets occur, there is the possibility of another route of administration (intramuscularly, intravenously once a week).

Arava (Leflunomide) for rheumatoid arthritis

The following dosage regimen is recommended: 100 mg every day for three days, followed by a transition to a maintenance daily dose of 20 milligrams.

For elderly patients with liver disease, the initial dose is 20 milligrams.

The effectiveness of methotrexate and leflunomide is on the same level, but the latter is easier to tolerate. There is evidence of a better prognosis of the quality of life of patients who took Leflunomide.

Methotrexate is the drug of first choice, since it has a lower cost. Leflunomide is prescribed if treatment with methotrexate is ineffective or poorly tolerated by the patient.

Reviews about the drug Metortrit (Methotrexate)

In their reviews of the drug, patients indicated that a lasting therapeutic effect occurs about six months after the start of the dose. 70% of patients manage to achieve control of rheumatoid arthritis (reducing the intensity of pain, reducing the frequency and duration of exacerbations) with the use of medium and high doses, others require the appointment of biological products. Metortrit is well tolerated.

Features of the appointment and use of sulfasalazine

Rheumatoid arthritis of moderate and low activity is an indication for treatment with sulfasalazine. The rheumatologist carries out an individual dose selection. During therapy, the patient is prescribed a blood test for liver enzymes, urea and creatinine to control the development of unwanted effects.

Second-line basic drugs

Cyclospotrin and hydroxychloroquine are included. They are less effective, but more toxic in comparison with first-line drugs. The duration of therapy with 2 rows is at least six months.

Genetically engineered (biological) drugs for the treatment of rheumatoid arthritis

The point of application of such drugs are specific components that affect the onset and progression of the disease. The drugs were created for the treatment of rheumatoid arthritis in patients who are resistant to standard treatment. With their help, it is possible to quickly achieve clinical remission.

Biological products for the treatment of arthritis with an autoimmune component include drugs that pointly block inflammation factors. This is achieved thanks to artificially created antibodies, soluble cytokine receptors, and other molecules with biological activity.

The action of biological drugs is aimed at “target molecules” and the suppression of immune inflammation. New drugs have high specificity and selectivity. They act exclusively on that link of the immune system that is involved in the development of the disease.

The most studied drugs are:

Patients for the treatment of which the above medicines were used note a rapid onset of effect. There is evidence on the inhibition of the destructive process in the joint. The disappearance of symptoms of exacerbation of the disease occurs within a few days after administration.

The phenomena of resistance to basic treatment are successfully overcome by biological means.

The negative effect of biological products on the body

Biologics are highly effective in the treatment of rheumatoid arthritis. However, their use has undesirable aspects:

  1. Anti-infective and anti-tumor immunity is inhibited.
  2. The risk of allergies, autoimmune processes increases, since biological agents are drugs with a protein structure that carry a large number of antigens.
  3. Treatment is expensive.

Prevention of undesirable effects of biological products

The patient before the start of therapy is examined for the presence of tuberculosis by fluorography. Other methods of preventing complications include vaccination, the purpose of which is to create active immunity. It should be noted that live vaccines are contraindicated in patients, since drugs have an immunosuppressive effect.

The principle of action of biological preparations

Tumor necrosis factor alpha is a biologically active substance that, in excessive concentration, causes degenerative processes. In patients with rheumatoid arthritis, there is an excessive accumulation of TNF-a in the synovial fluid. The drugs of the new generation include antibodies to TNF-a, which have a powerful anti-inflammatory effect. Blocking the synthesis of TNF-a prevents the destructive processes (destruction) of cartilage and bones.

Features of the use of Infliximab

The most famous biological drug is Infliximab (Remicade), represented by antibodies to TNF-a. Rheumatologists prescribe Remicade in conjunction with Methotrexate. In this case, there is a significant increase in the effectiveness of therapy (inhibition of the deformation of affected joints).

Indications for the use of Remicade:

  1. The insufficient therapeutic effect of taking methotrexate in an average or high dose.
  2. Preservation of signs of inflammation in 5 or more joints (pain, swelling, limitation of movement in the limb).
  3. The value of the erythrocyte sedimentation rate in the blood is thirty or more millimeters per hour.
  4. C-reactive protein in a biochemical blood test is 20 mg or more.
  5. The early age of the onset of rheumatoid arthritis and its severe course (rapid development of joint deformity). In the presence of such signs of the course of the disease, the appointment of combined treatment is required as soon as possible (Methotrexate plus Remicade).

Before starting therapy, the patient must exclude tuberculosis. For this, an X-ray examination of the chest, specific tests are performed.

Dosage regimen of the drug: the initial dose is administered intravenously drip with the calculation of 3 mg / kg. Repeated injections are given after two, six and eight weeks. Then, a maintenance dose (three mg / kg) is administered every eight weeks.

If treatment is ineffective, the dose of Infliximab is increased to ten mg / kg.

The duration of the course of therapy is determined by the rheumatologist individually, on average one year.

Features of the appointment and use of Rituximab (MabThera)

The mechanism of action of MabThera is the inhibition of B-lymphocytes (plasmocytes).

B-lymphocytes synthesize autoantibodies that destroy the cells of their own body. Plasmocytes are also involved in the regulation of the immune system. In clinical studies, a pronounced effect was noted in patients with an incomplete response to treatment with Infliximab.

Dosage regimen: a single dose (1 gram) is administered intravenously. Re-administration of the drug is carried out after two weeks in the same dosage. To prevent the development of adverse reactions to MabThera, prednisone is pre-administered.

The interval between repeated courses of treatment should be six months to a year.

Effective next-generation drugs in the treatment of rheumatoid arthritis

The effect of taking the medicine is proven in numerous clinical trials. A positive effect on the course of the disease was noted in Methotrexate, Arava, Sulfasalazine and biologics (Infliximab, Rituximab).

Group of drugsEffect on the course of the diseaseNegative sidesName
BasicSlow down the progress of rheumatoid arthritis, prevent joint deformation. Long term effectSlow actionMethotrexate Arava Sulfasalazine
Genetic engineering (new generation)Possess high efficiency and selectivity of actionCause a decrease in antitumor and anti-infection immunityInfliximab Rituximab Adalimumab Abasept
GlucocorticosteroidsThe inflammatory process is quickly stoppedA large number of side effects. Reception requires constant monitoring by a doctorDexamethasone Prednisolone Methylpred
Nonsteroidal anti-inflammatory drugs (NSAIDs)Stop the symptoms of inflammation in the acute phase of the diseaseDamage the mucous membrane of the digestive tract, have nephrotoxicityDiclofenac Meloxicam Nimesulide

Basic drugs for rheumatoid arthritis

Basic drugs are used in all patients with rheumatoid arthritis, if they have no contraindications. They relate to slow-acting agents. An important condition for successful therapy is an early appointment. The action is aimed at preventing deformation of the limbs, maintaining motor function.

The properties of the drugs include:

  1. Suppression of active proliferation of cells of the immune system.
  2. Persistence of clinical effect.
  3. Prevention of bone erosion in a damaged joint.
  4. Elongation of clinical remission of rheumatoid arthritis.

Medicines have different mechanisms of action and reception features, have a conditional division into the first and second row.

First-line drugs have the best ratio of effect and minimum unwanted actions. In numerous studies of these drugs, reliable suppression of the signs of the disease and the prevention of deforming processes in the joint have been proven.

The first row of basic medicines includes:

Features of the appointment and use of methotrexate

Methotrexate is the gold standard for rheumatoid arthritis. The weekly dose averages 20-30 milligrams, but is selected separately for each patient. Reception is recommended to start with small doses of 2,5-5 mg per week, followed by their increase.

Methotrexate regimen: every week for 2 days inside, dividing the dose into three doses (with an interval of eight hours). If gastrointestinal upsets occur, there is the possibility of another route of administration (intramuscularly, intravenously once a week).

Arava (Leflunomide) for rheumatoid arthritis

The following dosage regimen is recommended: 100 mg every day for three days, followed by a transition to a maintenance daily dose of 20 milligrams.

For elderly patients with liver disease, the initial dose is 20 milligrams.

The effectiveness of methotrexate and leflunomide is on the same level, but the latter is easier to tolerate. There is evidence of a better prognosis of the quality of life of patients who took Leflunomide.

Methotrexate is the drug of first choice, since it has a lower cost. Leflunomide is prescribed if treatment with methotrexate is ineffective or poorly tolerated by the patient.

Reviews about the drug Metortrit (Methotrexate)

In their reviews of the drug, patients indicated that a lasting therapeutic effect occurs about six months after the start of the dose. 70% of patients manage to achieve control of rheumatoid arthritis (reducing the intensity of pain, reducing the frequency and duration of exacerbations) with the use of medium and high doses, others require the appointment of biological products. Metortrit is well tolerated.

Features of the appointment and use of sulfasalazine

Rheumatoid arthritis of moderate and low activity is an indication for treatment with sulfasalazine. The rheumatologist carries out an individual dose selection. During therapy, the patient is prescribed a blood test for liver enzymes, urea and creatinine to control the development of unwanted effects.

Second-line basic drugs

Cyclospotrin and hydroxychloroquine are included. They are less effective, but more toxic in comparison with first-line drugs. The duration of therapy with 2 rows is at least six months.

Genetically engineered (biological) drugs for the treatment of rheumatoid arthritis

The point of application of such drugs are specific components that affect the onset and progression of the disease. The drugs were created for the treatment of rheumatoid arthritis in patients who are resistant to standard treatment. With their help, it is possible to quickly achieve clinical remission.

Biological products for the treatment of arthritis with an autoimmune component include drugs that pointly block inflammation factors. This is achieved thanks to artificially created antibodies, soluble cytokine receptors, and other molecules with biological activity.

The action of biological drugs is aimed at “target molecules” and the suppression of immune inflammation. New drugs have high specificity and selectivity. They act exclusively on that link of the immune system that is involved in the development of the disease.

The most studied drugs are:

Patients for the treatment of which the above medicines were used note a rapid onset of effect. There is evidence on the inhibition of the destructive process in the joint. The disappearance of symptoms of exacerbation of the disease occurs within a few days after administration.

The phenomena of resistance to basic treatment are successfully overcome by biological means.

The negative effect of biological products on the body

Biologics are highly effective in the treatment of rheumatoid arthritis. However, their use has undesirable aspects:

  1. Anti-infective and anti-tumor immunity is inhibited.
  2. The risk of allergies, autoimmune processes increases, since biological agents are drugs with a protein structure that carry a large number of antigens.
  3. Treatment is expensive.

Prevention of undesirable effects of biological products

The patient before the start of therapy is examined for the presence of tuberculosis by fluorography. Other methods of preventing complications include vaccination, the purpose of which is to create active immunity. It should be noted that live vaccines are contraindicated in patients, since drugs have an immunosuppressive effect.

The principle of action of biological preparations

Tumor necrosis factor alpha is a biologically active substance that, in excessive concentration, causes degenerative processes. In patients with rheumatoid arthritis, there is an excessive accumulation of TNF-a in the synovial fluid. The drugs of the new generation include antibodies to TNF-a, which have a powerful anti-inflammatory effect. Blocking the synthesis of TNF-a prevents the destructive processes (destruction) of cartilage and bones.

Features of the use of Infliximab

The most famous biological drug is Infliximab (Remicade), represented by antibodies to TNF-a. Rheumatologists prescribe Remicade in conjunction with Methotrexate. In this case, there is a significant increase in the effectiveness of therapy (inhibition of the deformation of affected joints).

Indications for the use of Remicade:

  1. The insufficient therapeutic effect of taking methotrexate in an average or high dose.
  2. Preservation of signs of inflammation in 5 or more joints (pain, swelling, limitation of movement in the limb).
  3. The value of the erythrocyte sedimentation rate in the blood is thirty or more millimeters per hour.
  4. C-reactive protein in a biochemical blood test is 20 mg or more.
  5. The early age of the onset of rheumatoid arthritis and its severe course (rapid development of joint deformity). In the presence of such signs of the course of the disease, the appointment of combined treatment is required as soon as possible (Methotrexate plus Remicade).

Before starting therapy, the patient must exclude tuberculosis. For this, an X-ray examination of the chest, specific tests are performed.

Dosage regimen of the drug: the initial dose is administered intravenously drip with the calculation of 3 mg / kg. Repeated injections are given after two, six and eight weeks. Then, a maintenance dose (three mg / kg) is administered every eight weeks.

If treatment is ineffective, the dose of Infliximab is increased to ten mg / kg.

The duration of the course of therapy is determined by the rheumatologist individually, on average one year.

Features of the appointment and use of Rituximab (MabThera)

The mechanism of action of MabThera is the inhibition of B-lymphocytes (plasmocytes).

B-lymphocytes synthesize autoantibodies that destroy the cells of their own body. Plasmocytes are also involved in the regulation of the immune system. In clinical studies, a pronounced effect was noted in patients with an incomplete response to treatment with Infliximab.

Dosage regimen: a single dose (1 gram) is administered intravenously. Re-administration of the drug is carried out after two weeks in the same dosage. To prevent the development of adverse reactions to MabThera, prednisone is pre-administered.

The interval between repeated courses of treatment should be six months to a year.

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.

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