Är adalimumab en bra behandling mot reumatoid artrit i jämförelse med andra biologiska läkemedel?

Sammanfattning: Rheumatoid arthritis (RA) is an autoimmune disease, which causes joint inflammation. Different environmental and genetic factors such as smoking, anti-citrullinated protein antibody, rheumatoid factor, and certain MHC-alleles cause RA. It affects mostly women and it is characterised by joint swelling, pain, tiredness, and stiffness. Untreated RA can lead to disability and complications in different organs (brain, lung, heart,). The body develops tolerance against self-antigens using different mechanisms, including Tregs mediated, by increasing the expression of inhibitory receptors and through receptor modification/destruction of self-reactive cells.  Failure in the resistance development mechanism leads to autoimmune diseases. The most important cellular components of RA dependent inflammation are macrophages, T-cells, and B-cells. These cells contribute to the inflammations process by producing antibodies, cytokines, and through antigen presentation or immune cell activation. One of the cytokines, which are released by macrophages and T-cells is Tumour necrosis factor (TNF). It stimulates angiogenesis, activation of osteoclasts and the production of different cytokines by increasing the expression of NF-kB.  The diagnostic process of RA consists of serological, physical, and radiological examinations. These examinations together with other factors are utilized for calculating score (0-10), in order to decide if a patient have RA or not. The treatment of RA depends on disease activity and it is composed of NSAID, steroids, DMARDs, biological DMARDs and non-pharmacological treatment. The interventions can be given as a monotherapy or in combination. The disease activity of RA or the efficacy of a drug which is used to treat RA can be studied by ACR response, DAS-28, HAQ-DI score using joint progression score. The aim of the study was to investigate the efficacy and safety of adalimumab, as well as to compare it with other treatments, which are used to in RA. 5 scientific articles which were obtained from PubMed were used to perform the study. The keywords used to get the materials was” adalimumab rheumatoid arthritis”. It gave 172 results and 5 of the first 20 were selected. ACR 20 response and change in DAS-28 were studied as a primary efficacy endpoint. The result of the studies demonstrated that adalimumab had a moderate-god effect against RA according to the ACR/ EULAR criteria. However, adalimumab was less effective comparing to barcitinib, tocilizumab, sirukumab but it had a similar efficacy as ABP 501 as well as abatacept.   ACR response, change in DAS-28 and remission rate showed better results in patients who treated by sirukumab, tocilizumab or barcitinib. The studies have also proved that adalimumab leads to better outcomes when it is used in combination with methotrexate instead of monotherapy. Regarding safety, all the drugs showed similar patterns and nasopharyngitis as well as lung infections were the most common adverse events. More studies are required in order to find the perfect target molecule and combination therapy so that RA can be treated efficiently and at a lower cost.