Advances in Targeted Therapies for Rehumatiod Arthritis: From Biologic to Small Molecule Inhibitors

Authors

  • Wasia Mansoor Virtual University of Pakistan, Lahore, Punjab, Pakistan.
  • Syed Muhammad Zain Ul Hassan University of Arizona, Tucson, AZ, USA.
  • Aziz ur Rahman Department of Pharmacy, University of Malakand, Chakdara, KP, Pakistan.
  • Anam Arshad Department of Biochemistry, Central Park Medical College, Lahore, Punjab, Pakistan.
  • Syeda Hira Waseem Lahore College for Women University, Lahore, Punjab, Pakistan.
  • Muhammad Mujtaba School of Chemistry, University of the Punjab, New Campus, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.777

Keywords:

Rheumatoid Arthritis, General Practitioners, Small Molecule Inhibitors, Biologics, Patient Compliance, Disease Progression, Punjab

Abstract

This study aimed to evaluate the knowledge, practices, and perceptions of General Practitioners (GPs) in Punjab, Pakistan, regarding the treatment of rheumatoid arthritis (RA) with biologics and small molecule inhibitors, focusing on patient compliance, disease progression, and treatment outcomes. A total of 108 GPs participated, with data collected through self-administered questionnaires, which were analyzed using descriptive statistics, cross-tabulation, and inferential statistics such as chi-square tests and t-tests. The findings revealed that GPs exhibited good knowledge of biologics, with experienced GPs (11-20 years of practice) showing higher awareness compared to less experienced practitioners. The study also highlighted that oral small molecule inhibitors had higher patient compliance (80%) compared to injectable biologics (60%), likely due to the convenience of oral administration. Both treatments showed significant reductions in disease activity, with injectable biologics demonstrating a more substantial impact on disease progression. The results suggest that while both biologics and small molecule inhibitors are effective in managing RA, patient compliance and treatment convenience are critical factors influencing treatment outcomes. This study provides key insights into the effectiveness, safety, and patient compliance of biologics and small molecule inhibitors in rheumatoid arthritis treatment. Injectable biologics showed a stronger impact on disease progression, while oral inhibitors had higher patient compliance due to convenience. More experienced GPs demonstrated greater knowledge of biologic therapies, emphasizing the need for continuous education. The findings highlight the importance of improving treatment accessibility and ensuring that GPs, especially in underserved areas, receive adequate training for optimal RA management. Future research should focus on long-term outcomes, cost-effectiveness, and patient-centered treatment strategies in RA management.

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References

Šenolt, L., Vencovský, J., Pavelka, K., Ospelt, C., & Gay, S. (2009). Prospective new biological therapies for rheumatoid arthritis. Autoimmunity Reviews, 9(2), 102-107. https://doi.org/10.1016/j.autrev.2009.03.010

Smolen, J. S., & Steiner, G. (2003). Therapeutic strategies for rheumatoid arthritis. Nature Reviews Drug Discovery, 2(6), 473-488. https://doi.org/10.1038/nrd1109

Mrid, R. B., Bouchmaa, N., Ainani, H., El Fatimy, R., Malka, G., & Mazini, L. (2022). Anti-rheumatoid drugs advancements: New insights into the molecular treatment of rheumatoid arthritis. Biomedicine & Pharmacotherapy, 151, 113126. https://doi.org/10.1016/j.biopha.2022.113126

Huang, J., Fu, X., Chen, X., Li, Z., Huang, Y., & Liang, C. (2021). Promising therapeutic targets for treatment of rheumatoid arthritis. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.686155

Tak, P. P., & Kalden, J. R. (2011). Advances in rheumatology: New targeted therapeutics. Arthritis Research & Therapy, 13(S1). https://doi.org/10.1186/1478-6354-13-s1-s5

Ding, Q., Hu, W., Wang, R., Yang, Q., Zhu, M., Li, M., Cai, J., Rose, P., Mao, J., & Zhu, Y. Z. (2023). Signaling pathways in rheumatoid arthritis: Implications for targeted therapy. Signal Transduction and Targeted Therapy, 8(1). https://doi.org/10.1038/s41392-023-01331-9

Abbasi, M., Mousavi, M. J., Jamalzehi, S., Alimohammadi, R., Bezvan, M. H., Mohammadi, H., & Aslani, S. (2018). Strategies toward rheumatoid arthritis therapy; the old and the new. Journal of Cellular Physiology, 234(7), 10018-10031. https://doi.org/10.1002/jcp.27860

Burmester, G. R., & Pope, J. E. (2017). Novel treatment strategies in rheumatoid arthritis. The Lancet, 389(10086), 2338-2348. https://doi.org/10.1016/s0140-6736(17)31491-5

Quan, L., Thiele, G. M., Tian, J., & Wang, D. (2008). The development of novel therapies for rheumatoid arthritis. Expert Opinion on Therapeutic Patents, 18(7), 723-738. https://doi.org/10.1517/13543776.18.7.723

Doma?ska-Pobo?a, J., & Wis?owska, M. (2025). Evolving strategies in the treatment of rheumatoid arthritis: A historical perspective. Rheumatology. https://doi.org/10.5114/reum/195012

Zerbini, C. A., Clark, P., Mendez-Sanchez, L., Pereira, R. M., Messina, O. D., Uña, C. R., Adachi, J. D., Lems, W. F., Cooper, C., & Lane, N. E. (2016). Biologic therapies and bone loss in rheumatoid arthritis. Osteoporosis International, 28(2), 429-446. https://doi.org/10.1007/s00198-016-3769-2

Kathoke, P., Thombre, K., Gupta, K. R., & Umekar, M. J. (2025). Innovative therapies and strategies for rheumatoid arthritis. Current Rheumatology Reviews, 21. https://doi.org/10.2174/011525H9AK6x69mzm9VFs5TPu9gcUUbduN6

Doan, T., & Massarotti, E. (2005). Rheumatoid arthritis: An overview of new and emerging therapies. The Journal of Clinical Pharmacology, 45(7), 751-762. https://doi.org/10.1177/0091270005277938

Smolen, J. S., & Aletaha, D. (2015). Rheumatoid arthritis therapy reappraisal: Strategies, opportunities and challenges. Nature Reviews Rheumatology, 11(5), 276-289. https://doi.org/10.1038/nrrheum.2015.8

Goldblatt, F., & Isenberg, D. A. (2005). New therapies for rheumatoid arthritis. Clinical and Experimental Immunology, 140(2), 195-204. https://doi.org/10.1111/j.1365-2249.2005.02744.x

Guo, Q., Wang, Y., Xu, D., Nossent, J., Pavlos, N. J., & Xu, J. (2018). Rheumatoid arthritis: Pathological mechanisms and modern pharmacologic therapies. Bone Research, 6(1). https://doi.org/10.1038/s41413-018-0016-9

Angelini, J., Talotta, R., Roncato, R., Fornasier, G., Barbiero, G., Dal Cin, L., Brancati, S., & Scaglione, F. (2020). JAK-inhibitors for the treatment of rheumatoid arthritis: A focus on the present and an outlook on the future. Biomolecules, 10(7), 1002. https://doi.org/10.3390/biom10071002

Moss, M. L., Sklair-Tavron, L., & Nudelman, R. (2008). Drug insight: Tumor necrosis factor-converting enzyme as a pharmaceutical target for rheumatoid arthritis. Nature Clinical Practice Rheumatology, 4(6), 300-309. https://doi.org/10.1038/ncprheum0797

Chaudhari, K., Rizvi, S., & Syed, B. A. (2016). Rheumatoid arthritis: Current and future trends. Nature Reviews Drug Discovery, 15(5), 305-306. https://doi.org/10.1038/nrd.2016.21

Buch, M. H., Eyre, S., & McGonagle, D. (2020). Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis. Nature Reviews Rheumatology, 17(1), 17-33. https://doi.org/10.1038/s41584-020-00541-7

Burmester, G. R., Feist, E., & Dörner, T. (2013). Emerging cell and cytokine targets in rheumatoid arthritis. Nature Reviews Rheumatology, 10(2), 77-88. https://doi.org/10.1038/nrrheum.2013.168

Choy, E. H., Kavanaugh, A. F., & Jones, S. A. (2013). The problem of choice: Current biologic agents and future prospects in RA. Nature Reviews Rheumatology, 9(3), 154-163. https://doi.org/10.1038/nrrheum.2013.8

Rashighi, M., Agarwal, P., Richmond, J. M., Harris, T. H., Dresser, K., Su, M., Zhou, Y., Deng, A., Hunter, C. A., Luster, A. D., & Harris, J. E. (2014). CXCL10 is critical for the progression and maintenance of Depigmentation in a mouse model of vitiligo. Science Translational Medicine, 6(223). https://doi.org/10.1126/scitranslmed.3007811

Conrad, C., & Gilliet, M. (2018). Psoriasis: From pathogenesis to targeted therapies. Clinical Reviews in Allergy & Immunology, 54(1), 102-113. https://doi.org/10.1007/s12016-018-8668-1

Brzustewicz, E., & Bryl, E. (2015). The role of cytokines in the pathogenesis of rheumatoid arthritis - Practical and potential application of cytokines as biomarkers and targets of personalized therapy. Cytokine, 76(2), 527-536. https://doi.org/10.1016/j.cyto.2015.08.260

Hogarth, P. M., & Pietersz, G. A. (2012). Fc receptor-targeted therapies for the treatment of inflammation, cancer and beyond. Nature Reviews Drug Discovery, 11(4), 311-331. https://doi.org/10.1038/nrd2909

Attwood, M. M., Fabbro, D., Sokolov, A. V., Knapp, S., & Schiöth, H. B. (2021). Trends in kinase drug discovery: Targets, indications and inhibitor design. Nature Reviews Drug Discovery, 20(11), 839-861. https://doi.org/10.1038/s41573-021-00252-y

Sweeney, S. E., & Firestein, G. S. (2004). Rheumatoid arthritis: Regulation of synovial inflammation. The International Journal of Biochemistry & Cell Biology, 36(3), 372-378. https://doi.org/10.1016/s1357-2725(03)00259-0

Townsend, M. J., Monroe, J. G., & Chan, A. C. (2010). B?cell targeted therapies in human autoimmune diseases: An updated perspective. Immunological Reviews, 237(1), 264-283. https://doi.org/10.1111/j.1600-065x.2010.00945.x

Mease, P. J., & Antoni, C. E. (2005). Psoriatic arthritis treatment: Biological response modifiers. Annals of the Rheumatic Diseases, 64, ii78-ii82. https://doi.org/10.1136/ard.2004.034157

ZWERINA, J., REDLICH, K., SCHETT, G., & SMOLEN, J. S. (2005). Pathogenesis of rheumatoid arthritis: Targeting cytokines. Annals of the New York Academy of Sciences, 1051(1), 716-729. https://doi.org/10.1196/annals.1361.116

Aletaha, D., & Smolen, J. S. (2018). Diagnosis and management of rheumatoid arthritis. JAMA, 320(13), 1360. https://doi.org/10.1001/jama.2018.13103

Legraverend, M., & Grierson, D. S. (2006). The purines: Potent and versatile small molecule inhibitors and modulators of key biological targets. Bioorganic & Medicinal Chemistry, 14(12), 3987-4006. https://doi.org/10.1016/j.bmc.2005.12.060

Harrington, R., Al Nokhatha, S. A., & Conway, R. (2020). JAK inhibitors in rheumatoid arthritis: an evidence-based review on the emerging clinical data. Journal of Inflammation Research, 13, 519-531. https://doi.org/10.2147/jir.s219586

Malemud, C. J. (2018). The role of the JAK/STAT signal pathway in rheumatoid arthritis. Therapeutic Advances in Musculoskeletal Disease, 10(5-6), 117-127. https://doi.org/10.1177/1759720x18776224

Felten, R., Scher, F., Sibilia, J., Gottenberg, J., & Arnaud, L. (2019). The pipeline of targeted therapies under clinical development for primary Sjogren's syndrome: A systematic review of trials. Autoimmunity Reviews, 18(6), 576-582. https://doi.org/10.1016/j.autrev.2018.12.008

Gadina, M., Johnson, C., Schwartz, D., Bonelli, M., Hasni, S., Kanno, Y., Changelian, P., Laurence, A., & O'Shea, J. J. (2018). Translational and clinical advances in JAK-STAT biology: The present and future of jakinibs. Journal of Leukocyte Biology, 104(3), 499-514. https://doi.org/10.1002/jlb.5ri0218-084r

Tanaka, Y. (2015). Recent progress and perspective in JAK inhibitors for rheumatoid arthritis: From bench to bedside. Journal of Biochemistry, 158(3), 173-179. https://doi.org/10.1093/jb/mvv069

Widakowich, C., De Castro, G., De Azambuja, E., Dinh, P., & Awada, A. (2007). Review: Side effects of approved molecular targeted therapies in solid cancers. The Oncologist, 12(12), 1443-1455. https://doi.org/10.1634/theoncologist.12-12-1443

Hodge, J. A., Kawabata, T. T., Krishnaswami, S., Clark, J. D., Telliez, J. B., Dowty, M. E., ... & Zwillich, S. (2016). The mechanism of action of tofacitinib-an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Clin Exp Rheumatol, 34(2), 318-328.

Taylor, P. C. (2019). Clinical efficacy of launched JAK inhibitors in rheumatoid arthritis. Rheumatology, 58(Supplement_1), i17-i26. https://doi.org/10.1093/rheumatology/key225

Henley, M. J., & Koehler, A. N. (2021). Advances in targeting 'undruggable' transcription factors with small molecules. Nature Reviews Drug Discovery, 20(9), 669-688. https://doi.org/10.1038/s41573-021-00199-0

Peifer, C., Wagner, G., & Laufer, S. (2006). New approaches to the treatment of inflammatory disorders small molecule inhibitors of p38 MAP kinase. Current Topics in Medicinal Chemistry, 6(2), 113-149. https://doi.org/10.2174/156802606775270323

McInnes, I. B., Buckley, C. D., & Isaacs, J. D. (2015). Cytokines in rheumatoid arthritis - shaping the immunological landscape. Nature Reviews Rheumatology, 12(1), 63-68. https://doi.org/10.1038/nrrheum.2015.171

Baudino, T. (2015). Targeted cancer therapy: The next generation of cancer treatment. Current Drug Discovery Technologies, 12(1), 3-20. https://doi.org/10.2174/1570163812666150602144310

Iwata, S., & Tanaka, Y. (2016). Progress in understanding the safety and efficacy of Janus kinase inhibitors for treatment of rheumatoid arthritis. Expert Review of Clinical Immunology, 12(10), 1047-1057. https://doi.org/10.1080/1744666x.2016.1189826

Grant, S. K. (2008). Therapeutic protein kinase inhibitors. Cellular and Molecular Life Sciences, 66(7), 1163-1177. https://doi.org/10.1007/s00018-008-8539-7

YASUDA, Y., KALETA, J., & BROMME, D. (2005). The role of cathepsins in osteoporosis and arthritis: Rationale for the design of new therapeutics. Advanced Drug Delivery Reviews, 57(7), 973-993. https://doi.org/10.1016/j.addr.2004.12.013

Rask-Andersen, M., Zhang, J., Fabbro, D., & Schiöth, H. B. (2014). Advances in kinase targeting: Current clinical use and clinical trials. Trends in Pharmacological Sciences, 35(11), 604-620. https://doi.org/10.1016/j.tips.2014.09.007

Rønholt, K., & Iversen, L. (2017). Old and new biological therapies for psoriasis. International Journal of Molecular Sciences, 18(11), 2297. https://doi.org/10.3390/ijms18112297

Schwartz, D. M., Kanno, Y., Villarino, A., Ward, M., Gadina, M., & O'Shea, J. J. (2017). JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nature Reviews Drug Discovery, 16(12), 843-862. https://doi.org/10.1038/nrd.2017.201

Bartok, B., & Firestein, G. S. (2009). Fibroblast?like synoviocytes: Key effector cells in rheumatoid arthritis. Immunological Reviews, 233(1), 233-255. https://doi.org/10.1111/j.0105-2896.2009.00859.x

Franks, S. E., Getahun, A., Hogarth, P. M., & Cambier, J. C. (2016). Targeting B cells in treatment of autoimmunity. Current Opinion in Immunology, 43, 39-45. https://doi.org/10.1016/j.coi.2016.09.003

Nygaard, G., & Firestein, G. S. (2020). Restoring synovial homeostasis in rheumatoid arthritis by targeting fibroblast-like synoviocytes. Nature Reviews Rheumatology, 16(6), 316-333. https://doi.org/10.1038/s41584-020-0413-5

Narazaki, M., Tanaka, T., & Kishimoto, T. (2017). The role and therapeutic targeting of IL-6 in rheumatoid arthritis. Expert Review of Clinical Immunology, 13(6), 535-551. https://doi.org/10.1080/1744666x.2017.1295850

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Published

2025-03-12

How to Cite

Mansoor, W., Hassan, S. M. Z. U., Rahman , A. ur, Arshad, A., Waseem, S. H., & Mujtaba , M. (2025). Advances in Targeted Therapies for Rehumatiod Arthritis: From Biologic to Small Molecule Inhibitors. Indus Journal of Bioscience Research, 3(3), 76-88. https://doi.org/10.70749/ijbr.v3i3.777