Addressing Challenges in RA : The Role of B- and T-Cell Targeted Therapies
The pathogenesis of autoimmune disorders such as rheumatoid arthritis (RA) is complex, involving all elements of the immune system, including B cells, T cells, innate recognition systems, pathogenic antibodies, and complement and effector cells. The role of T cells in the pathogenesis of RA has been well characterized, leading to the development and approval of biologic therapy, such as the tumor necrosis factor (TNFα) and IL-1 receptor antagonists. Despite the success of these agents in treating RA, about one-third of patients remain unresponsive to biologic therapy.
The role of B cells in the pathogenesis of RA is not as well defined as that of T cells; however, early studies showed that targeting B cells resulted in sustained ACR50 and ACR70 responses. This triggered a major shift in thinking about this disease. Multiple B-cell targets are now a focus of further study.
An unprecedented number of randomized controlled trials in rheumatology have been conducted in the past decade, bringing much clinical data to practical application in the community. To bridge the gap between leading-edge research and the clinic, recent consensus statements have provided guidelines for the use of T- and B-cell–targeted agents. An understanding of the pathophysiology of RA, recent clinical trial data, and the clinical application of T- and B-cell therapies in RA is essential to improving patient care.
ACR 2007 Highlights
Pathophysiology 2007