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Advances in the development and application of biological therapies for rheumatoid arthritis: review of the latest clinical evidence

Sarah C Horton, Maya H Buch

Since the introduction of the first biological therapies for rheumatoid arthritis – the TNF inhibitors (TNFi) etanercept, infliximab and adalimumab – other biologic agents have been developed and are now approved for use. This article summarizes the evidence for new TNFi (certolizumab and golimumab), B-cell-depleting therapy (rituximab), T-cell co‑stimulation modulating therapy (abatacept) and an IL-6 receptor inhibitor (tocilizumab). A proportion of patients may not be suitable for these or may remain resistant to multiple therapies; thus, new biological agents in development will be discussed. Advances in the application of biologic therapies will be explored, including the use of biologics in early rheumatoid arthritis, towards achieving predefined targets, and the emergence of biomarkers introducing the prospect of personalized therapy.