Rheumatoid arthritis, treatment monoclonal antibody therapy

Keystone, E. C., Kavanaugh, A. E., Sharp, J. T., et al. (2004) Radiographic, cUnical, and functional outcomes of treatment with adaUmumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy a randomized, placebo-controUed, 52-week trial. Arthritis and Rheumatism. 50, 1400-1411. 

The first therapeutic antibody approved (Orthoclone OKT-3 or Muromonab CD3, 1986) was indicated not for cancer treatment, but for controlling acute rejection of transplanted organs (kidney, heart, and liver). Nowadays, other clinical indications such as asthma, rheumatoid arthritis, psoriasis, and Crohn s disease are treated with mAbs (see Chapter 17) (Antibody Engineering and Manufacture, 2005 Monoclonal Antibodies and Therapies, 2004 Hot Drugs, 2004 Walsh, 2004). 

Another TNFa monoclonal antibody known as etanercept (a fusion protein of human IgG and two p75 TNF receptors) [98] that is a competitive inhibitor of TNF s cell-surface receptor has been developed. Clinical studies have shown that etanercept therapy results in significant clinical benefits and is well tolerated and safe for long-term use [99-101]. Etanercept is given subcutaneously (25 mg) twice weekly for the treatment of rheumatoid arthritis [98]. It is also used in the treatment of psoriatic arthritis, and a recent clinical trial has reported that in addition to decreasing joint pain and fatigue, etanercept also decreases symptoms of depression associated with this chronic disease [102]. 

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