Rheumatoid arthritis (RA) is a chronic disease that affects the joints and causes pain, inflammation and stiffness. Treatments for rheumatoid arthritis are designed to control inflammation, relieve pain and prevent joint damage.

Treatments of rheumatoid arthritis

Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs are used to manage the symptoms of the disease by reducing inflammation and relieving pain. The most common NSAIDs are ibuprofen and naproxen.

Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow or stop disease progression by acting on the immune system. The most prescribed DMARDs are methotrexate, leflunomide and hydroxychloroquine.

Corticosteroids: These cortisone-based drugs (corticosteroids) are hormones that decrease inflammation.

Biotherapies: These drugs target the proteins that cause inflammation in the body. Biotherapies are very effective and can put the disease to rest when properly prescribed.

Surgery: Surgery is sometimes needed to repair or replace joints damaged by the disease.

The biotherapy revolution

Biotherapy is the use of biological substances, such as proteins, antibodies, living cells or genes, to treat diseases. Biotherapy is now used to treat a variety of diseases, such as cancer, autoimmune diseases, infectious diseases, and genetic diseases. These next-generation treatments have revolutionized the management of many diseases by providing more targeted and effective treatment options than traditional therapies.

How are biotherapies made?

The production process of a biotherapy is complex and expensive. It requires expertise in biotechnology, production engineering and regulation. The manufacture of a biologic consists of isolating cells or bacteria to genetically modify them by incorporating a particular gene called "expression gene". This manipulation will allow the cell to produce the desired protein to treat the targeted pathology. These single-cell organisms are then transferred to an incubator where they are mass-grown to multiply and produce the protein. This protein is then extracted and purified to be put into pharmaceutical form.

The main steps in the manufacture of a biomedicine product

The various types of biotherapy for rheumatoid arthritis

TNFα inhibitors
TNFα (tumor necrosis factor alpha) is an inflammatory cytokine produced by the immune system in response to infection or inflammation. TNFα inhibitors are antibodies that block TNFα and prevent its action, thus reducing inflammation. The most commonly used TNFα inhibitors are infliximab, adalimumab, golimumab, and certolizumab.

Interleukin inhibitors
Interleukin inhibitors (IL inhibitors) are a class of biologics that target interleukins (IL), a group of cytokines involved in the regulation of the immune system and inflammation.The most commonly used IL inhibitors are anti-IL-1, anti-IL-6, and anti-IL-17, which block interleukins 1, 6, and 17, respectively.

Lymphocyte inhibitors
Lymphocyte inhibitors are immunosuppressors that target lymphocytes, which are immune cells playing a key role in the immune response.

There are several types of lymphocyte inhibitor, in particular monoclonal antibodies which target T-cell receptors, such as alemtuzumab, basiliximab, daclizumab, and OKT3, and purine synthesis inhibitors, such as azathioprine and mycophenolate mofetil.

Rituximab is a biologic that targets B lymphocytes, a type of immune cell involved in the immune response and in certain auto-immune diseases. Rituximab is a chimeric monoclonal antibody which binds specifically to a protein called CD20, which is present on the surface of B cells. Rituximab destroys abnormal or hyperactive B cells, thus reducing inflammation and disease progression. It can also reduce the number of healthy B cells, thereby increasing the risk of infection.

Abatacept is a biologic that blocks the activation of T cells, a type of immune cell that plays a key role in the immune response and in the progression of auto-immune diseases. It is a fusion monoclonal antibody which binds to a protein called CD80/86, present on the surface of antigen-presenting cells, which activate T cells.

Les modes d’administration des biothérapies dans la polyarthrite rhumatoïde

Les biothérapies peuvent être administrées de plusieurs manières : Injection sous-cutanée : l’injection se fait sous la peau à l'aide d'une seringue ou d'un stylo d'injection. Injection intraveineuse : l’injection se fait dans une veine à l'aide d'une aiguille ou d'un cathéter. Injection intramusculaire : l’injection se fait dans un muscle à l'aide d'une seringue. D’autres modes d’administration existent pour traiter d’autres pathologies.

Biothérapies et effets secondaires

Comme toute thérapie médicamenteuse, les biothérapies peuvent présenter des effets secondaires, et leur utilisation doit être surveillée et encadrée par des professionnels de santé. Les effets secondaires d’une biothérapie peuvent varier d’un individu à l’autre. Les facteurs âge, antécédents médicaux et l’état de santé globale du patient jouent un rôle dans les effets secondaires du traitement. Ils différent également en fonction de la biothérapie utilisée.