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The impact of biologic therapy for rheumatoid arthritis on quality of life has clear relevance to studies of the cost-effectiveness of these agents. As discussed in this Viewpoint, however, several deficiencies in current economic evaluations need to be overcome in order to enhance the utility of such research.
Although rituximab specifically binds to CD20 on B cells, it also has efficacy in the treatment of autoimmune diseases that are predominantly mediated by T helper cells. In this Viewpoint, Dr Datta proposes a novel hypothesis to explain this: the association of the pathogenic autoreactive T cells with anti-CD20 opsonized B cells might in fact make rituximab specific for autoreactive T cells.
A considerable increase in the risk of developing cardiovascular disease is conveyed not only by inflammation, but also by the use of glucocorticoids to treat inflammation. In this Viewpoint, the authors discuss the challenge of balancing the relative benefits and hazards of glucocorticoid treatment for inflammatory diseases, as well as the tantalizing prospect of identifying subgroups of the population at risk for cardiovascular disease.
Updated guidance from the UK National Institute for Health and Clinical Excellence on the use of tumor necrosis factor (TNF) antagonists for rheumatoid arthritis recommends that patients who do not respond to initial anti-TNF therapy should not switch to another TNF inhibitor. In this Viewpoint, the authors discuss the rationale and controversies surrounding this recommendation.
Since 1998, six new drugs have been approved for the treatment of rheumatoid arthritis, with the hope of at least two more in the next year—a unique success story in terms of drug approval for one indication. In this Review, Dr Schwieterman discusses the history of clinical trial design for new rheumatoid arthritis therapeutics, what we have learnt and the challenges that lie ahead.
Tuberculosis is one of the most common severe infections seen in patients receiving tumor necrosis factor inhibitors, and nontuberculous mycobacterial infection is an increasingly recognized condition in this setting. In this Review article, van Ingen et al. highlight the drug-related risks, clinical presentation, and screening and prevention of mycobacterial disease in patients undergoing treatment with biological agents.
Evidence from animal models indicates that B cells have both pathogenic and protective functions in autoimmune diseases. In this Review, the authors highlight recent insights into the suppressive functions of activated B cells in mice, describe the potential of B cells for use as cell-based therapy for experimental autoimmune diseases, and finally discuss the possibility of translating this cellular approach to treat human autoimmune diseases.