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Selective Costimulation Modulators: Addressing Unmet Needs in Rheumatoid Arthritis Management: Unmet Needs in the Treatment of Rheumatoid Arthritis


Unmet Needs in the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that causes progressive joint destruction, pain, and significant physical limitation. The course of RA is characterized by alternating remissions and exacerbations, and long-term treatment is usually required to prevent disease flares.[1]

Studies that have examined the prevalence of RA among twin pairs have consistently found that the concordance rate of RA is approximately 12% to 15% among monozygotic twins and approximately 3.5% among dizygotic twins.[2,3] This suggests that both genetic and environmental factors are important in the pathogenesis of RA.

It is estimated that more than 2 million people in the United States have RA. Epidemiologic studies conducted in Europe and the United States have generally reported prevalence estimates of .5% to 1% among adults, although the prevalence of RA is considerably higher than this in some populations (eg, as high as 5% to 8% among Chippewa and Pima American Indian tribes).[1] The age of onset is variable, but the mean age at first symptoms of RA is typically between 50 and 60 years. The disease results in an average decrease in life expectancy of approximately 5-10 years.[4,5] RA is more common in women than in men.[6,7]

Synthetic disease-modifying antirheumatic drugs (DMARDs) have long been used to slow the progression of joint destruction in patients with RA. However, these agents fail to significantly improve the course of RA in a substantial number of patients, and they are associated with considerable toxicity. During the last decade, a number of biological DMARDs, specifically agents that target inflammatory cytokines, have entered clinical practice. These agents are effective for the treatment of RA and are generally well tolerated. However, many patients still do not respond adequately to treatment with these available medications, even when they are used in combination with synthetic DMARDs.[8] Stopping treatment with these drugs generally leads to disease flares.[9] Thus, there remains a significant unmet need for new, clinically efficacious therapies for RA.