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Selective Costimulation Modulators: Addressing Unmet Needs in Rheumatoid Arthritis Management

Authors: Paul Emery, MA, MD, FRCP ; John C. Davis, Jr, MD, MPH, FACR, FACP ; Lars Klareskog, MD, PhD ; Rene R. Westhovens, MD, PhDFaculty and Disclosures



Data from recent clinical trials of targeted biological therapies for the treatment of rheumatoid arthritis (RA) were presented last June at the 2004 European League Against Rheumatism (EULAR) meeting, held in Berlin, Germany. The clinical results presented for a novel agent that targets costimulatory activation of T cells, a central step in the immunologic response that eventually leads to joint destruction in RA, are discussed. Given the expanding number of biological targeted therapies available for treating RA, a working knowledge of the immune mechanisms underlying the disease has become a requirement for evaluating these new treatment options. This information should also help clinicians recognize the advantages and limitations of the available therapies and assist in the consideration of alternatives. This article first briefly reviews our current knowledge of the immunologic basis of RA. The next 2 sections examine how this knowledge has led to the development of novel, targeted biological agents. These agents have the potential not only to slow the progression of RA, but also to reverse the course of the disease, bringing the ultimate goal of a permanent remission closer.