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Why aren’t biologics used right away if they’re so effective?

Although the etiopathogenesis of rheumatoid arthritis is not yet well understood, in the 1990s it was shown that chronic inflammation is caused by a disruption of the physiological balance between pro-inflammatory (in favor of inflammation) and anti-inflammatory proteins. (which inhibit inflammation).

These pro-inflammatory proteins are termed CYTOKINES.

Cytokines are produced by cells of the immune system (more specifically by white blood cells) and are needed, under normal conditions, to fight environmental insults such as infections.
Inflammation is therefore a necessary mechanism within our body, however, it must be limited in time, otherwise it would cause tissue damage.

Rheumatoid arthritis is characterized precisely by the breakdown of this balance; cellular overflow and accumulation of pro-inflammatory proteins occur in the joint sites causing: pain, swelling, muscle and joint stiffness.

All symptoms that if not treated adequately cause irreparable damage such as the destruction of the joints and consequent disability.

Over the past 20 years, biologic drugs have taken over the market.
These are drugs that derive from the laboratory synthesis of antibodies and receptors which emulate the behavior of natural anti-inflammatory proteins, blocking excessive inflammatory decompensation.

To date, biological drugs are among the most effective in the treatment of rheumatoid arthritis.

However, the availability of access by patients is extremely limited and their use is reserved for subjects with active rheumatoid arthritis (high DAS) and for subjects to whom conventional therapies have proved ineffective.

In a research carried out by Clicon Health, Economics Outcome Research in collaboration with ASL found that of the approximately 400,000 patients suffering from rheumatoid arthritis in Italy, only 43,000 are being treated with biologics, the remaining 357,000 are under conventional therapies.

Why aren’t biologics used right away if they’re so effective?

The scarcity of tools available to “read” the molecular profile of the patient means that setting up a correct drug therapy is complicated.

Drug-related complications are events that interfere with desired health outcomes 14, in fact, high incidences are found in RA patients, such as drug interactions, dosing problems, drug choice problems and side effects. 15

Despite the effectiveness of biologics in treating the disease, not all patients respond correctly.

Molecular drugs (biological drugs) represent an essential element in the treatment of the disease, precisely because they are very effective. on a specific disease and for a particular group of patients for whom they were designed.
It is therefore of fundamental importance to identify the correct drug for the right patient.

Everyone has the right to personalized medical treatment capable of determining the best possible health result, which takes into account all the relevant individual characteristics, such as: the genotypic and phenotypic characteristics of the individual, age, the presence of multiple pathologies ( comorbidities), taking multiple medicines, lifestyle and psychosocial conditions.

iCareX adopts an individual-centric approach in helping patients with RA to better understand and characterize their disease. With our test-exploRA we analyze the uniqueness of the gene expression of each individual by translating the scientific knowledge accumulated over the last twenty years into a simple and informative report to accompany the individual in his first steps towards the medicine of precision.

References:

14. Pharmaceutical Care Network Europe Foundation (PCNE) PCNE classification for drug related problems version 5.01. 2006. [Accessed December 18, 2017]. Available from:

15. Ernst ME, Iyer SS, Doucette WR. Drug-related problems and quality of life in arthritis and low back pain sufferers. Value Health. 2003; 6 (1): 51–58.

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