What experimental therapies are under investigation for the management of rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Despite significant advances over the past decades, RA continues to be a chronic disease. It remains active in many patients whose conditions partially or completely fail to respond to DMARDs. Therefore, the vigorous search for new therapeutic agents continues.

Several new CD20 B-cell−targeted biologic agents are under investigation, including atacicept, AMG 623, B3-FCc, Br3-Fc, belimumab, epratuzumab, ofatumumab, ocrelizumab, and TRU-015. Small molecules directed at enzymes involved in signal transduction of TNF and other proinflammatory cytokines are effective in treating RA.

A phase II study reported that in comparison with placebo, fostamatinib, an inhibitor of spleen tyrosine kinase (Syk), reduced disease activity in RA patients who did not have a response to MTX therapy. [136] Further investigation is required to determine the safety and efficacy of this agent in RA patients.

Inhibition of matrix metalloproteinases (MMPs), though initially unsuccessful, could prove to be efficacious, as could inhibition of osteoclast activation. Apheresis procedures are also being investigated. High-dose immunosuppression combined with autologous stem cell transplantation has been used in study protocols for patients whose conditions are resistant to other therapies.


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