Currently available bDMARDs for inflammatory rheumatic diseases

What biologic agents (biologic disease-modifying antirheumatic drugs [bDMARDs]) are currently available for use in the treatment of inflammatory rheumatic diseases?

With our increased understanding of the pathogenesis of autoimmune rheumatic diseases, several bDMARDs have been developed for treatment, especially for RA, ankylosing spondylitis (AS), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), cryopyrinopathies/cryopyrin-associated autoinflammatory syndromes (CAPS), systemic lupus erythematosus (SLE), and primary vasculitides. These can be classified as follows:

  • Cytokine-targeted therapies:
  • • TNF-α inhibitors: etanercept (ETN), infliximab (INF), adalimumab (ADA), golimumab, certolizumab.
  • • TNF-α inhibitor biosimilars: ETN-szzs, ETN-ykro, INF-dyyb, INF-abba, INF-qbtx, ADA-atto, ADA-abdm, ADA-adaz.
  • • IL-1 inhibitors: anakinra, rilonacept, canakinumab.
  • • Anti-IL-5: mepolizumab. Anti-IL-5 receptor: berralizumab.
  • • Anti-IL-6 receptor: tocilizumab, sarilumab. Anti-IL-6: siltuximab.
  • • Anti-IL-12/IL-23: ustekinumab.
  • • Anti-IL-17A: secukinumab, ixekizumab. Anti-IL-17 receptor: brodalumab.
  • • Anti-IL-23: guselkumab, tildrakizumab, risankizumab.
  • B-cell-targeted therapies:
  • • Rituximab (RTX, anti-CD20),ocrelizumab (anti-CD20)
  • • B-cell growth factor inhibitors: belimumab (anti-Blys).
  • T-cell-targeted therapies:
  • • Costimulatory molecule inhibitors: abatacept (anti-CD80/86).
  • Complement-targeted therapies:
  • • Eculizumab (anti-C5).

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