Recent Advances in the Treatment of Rheumatoid Arthritis

Tina D. Mahajan; Ted R. Mikuls


Curr Opin Rheumatol. 2018;30(3):231-237. 

In This Article

Abstract and Introduction


Purpose of review: Therapies for rheumatoid arthritis (RA) continue to expand rapidly. The purpose of this review is to discuss novel treatment options, including biosimilars, that are available, as well as to highlight promising agents in development. The purpose is also to discuss new emerging safety signals associated with these drugs and to discuss strategies in tapering therapy.

Recent findings: There are several novel RA therapies. These include the interleukin-6 (IL-6) receptor blocker sarilumab, which was approved in 2017. In aggregate, the sarilumab studies show that it is effective in RA, including patients with incomplete responses to methotrexate and anti-tumor necrosis factor inhibitor, and showing superior efficacy when used in higher dose (200 mg every 2 weeks) to standard-dose adalilumab. Other drugs that are currently being studied include the IL-6 cytokine blocker sarikumab, the small targeted molecule filgotinib, and many new biosimilars. Baracitinib failed to achieve approval by the Food and Drug Administration primarily over perceived safety concerns. The two biosimilar drugs currently approved are CT-P13 and SB2, which are based on the reference product infliximab. Although this review summarizes trials examining biologic tapering, additional data are needed to guide clinicians in regards to treatment de-escalation in RA.

Summary: With the greatly expanded armamentarium of RA treatment options available, it is important for clinicians to understand the data regarding drug efficacy and safety. With remission increasingly attainable, effective drug tapering strategies are needed. Although tapering trials do exist, more studies will be needed to help guide clinical practice.


Rheumatoid arthritis (RA) is a chronic, progressive disease that, left untreated, leads to progressive joint destruction and disability. Although there are many RA treatment options available, many agents are at best only partially effective or induce remission in only a minority of patients. Therefore, there remains an unmet need for treatments that provide excellent response and are cost-effective. The goal of this review is to identify novel therapies including both biologic and targeted synthetic disease modifying antirheumatic drugs (DMARDs), emerging safety issues with available agents, and data addressing the possibility of tapering therapies once remission is achieved.