Since the late 1990s, based on scientific advancement and biotechnological improvement, many effective drugs such as leflunomide and biologic agents for rheumatoid arthritis (RA) have been developed. These include TNF-alpha inhibitors such as etanercept, infliximab, and adalimumab, a peripheral B-cell depleting agent such as rituximab, CTLA-4 Ig such as abatacept, and IL-1 receptor antagonist such as anakira. These new agents have provided good efficacy in the treatment of patents with severe or refractory rheumatoid arthritis and have provided retardation or prevention of radiographic progression or joint destruction despite some side effects such as tuberculosis, infection, malignancies. In this review, new therapeutic alternatives would be given, and chances for more improved outcomes in the care of patients with rheumatoid arthritis provided.
Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Antibodies, Monoclonal, Murine-Derived ; Arthritis, Rheumatoid ; B-Lymphocytes ; Humans ; Immunoconjugates ; Immunoglobulin G ; Interleukin-1 ; Isoxazoles ; Joints ; Receptors, Tumor Necrosis Factor ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Rituximab ; Abatacept ; Adalimumab ; Infliximab ; Etanercept

BACKGROUND: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacy compared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. The objective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab with conventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under the condition of the reimbursement coverage criteria in Korea. METHODS: A systematic review was conducted using MEDLINE and Cochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesian outcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR was greater than one. RESULTS: Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR response rates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) for Golimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. In ACR50 and ACR70, the ORs did not present significant differences. CONCLUSION: Certolizaumab with cDMARD was more effective or comparable than other bDMARDs in patients who failed prior cDMARD treatment.
Antirheumatic Agents* ; Arthritis, Rheumatoid* ; Humans ; Korea ; Odds Ratio ; Rheumatology ; Abatacept ; Adalimumab ; Infliximab ; Rituximab ; Etanercept

OBJECTIVE: Rheumatoid arthritis (RA) patients suffer from an increased risk of herpes zoster (HZ) partially due to immunosuppressant medications. This study investigated HZ in RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs), as compared with conventional DMARDs (cDMARDs). METHODS: This retrospective case series study assembled record information of 277 RA patients who received bDMARDs after failure of at least one cDMARDs at Seoul National University Hospital between August 2003 and February 2015. Following capture of baseline information and identification of HZ episodes, crude HZ incidence rates per 100 patient-years (95% confidence intervals) were calculated. RESULTS: For 718 treatment courses, 277 (38.6%) comprised cDMARDs, 66 (9.2%) infliximab, 175 (24.4%) etanercept, 95 (13.2%) adalimumab, 9 (1.3%) golimumab, 41 (5.7%) rituximab, 31 (4.3%) abatacept, and 24 (3.3%) tocilizumab. There were 37 HZ episodes, 16 during cDMARD treatment courses, and 21 accompanying bDMARDs, two with infliximab, eight with etanercept, five with adalimumab, and three each with rituximab and abatacept. The crude HZ incidence rate per 100 patient-years was 2.4 (1.4∼3.9) for cDMARDs, 2.2 (0.3∼7.9) for infliximab, 1.8 (0.8∼3.6) for etanercept, 3.7 (1.2∼8.4) for adalimumab, 3.9 (0.8∼11.0) for rituximab, and 8.5 (1.8∼23.1) for abatacept. CONCLUSION: We conclude that bDMARDs do not always increase the risk of HZs in RA patients, although HZ rates vary for different bDMARDs.
Abatacept ; Adalimumab ; Antirheumatic Agents ; Arthritis, Rheumatoid* ; Biological Therapy ; Etanercept ; Herpes Zoster* ; Humans ; Incidence ; Infliximab ; Retrospective Studies ; Rituximab ; Seoul

No abstract available.
Antibodies, Anti-Idiotypic ; Antibodies, Monoclonal, Humanized ; Urticaria ; Omalizumab

The efficacy of anti-TNF-alpha antibodies including infliximab and adalimumab for refractory intestinal Behcet's disease has recently been demonstrated in a series of case reports. The efficacy of switching to a different kind of anti-TNF-alpha agent in the face of refractoriness to one kind of anti-TNF-alpha agent, a common practice of proven efficacy in rheumatoid arthritis, has yet not been reported for intestinal Behcet's disease. In the present study, we report a case of 52-year-old female patient with intestinal Behcet's disease, who lost initial good response to infliximab, and was refractory to subsequent administrations of adalimumab. Her recent relapse of intestinal lesions could be successfully treated with etanercept. This case suggests that switching to etanercept might be a reasonable therapeutic option in case of intestinal Behcet's disease with secondary non-response to anti-TNF-alpha antibodies that is most likely to be mediated by anti-drug antibody.
Antibodies ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Arthritis, Rheumatoid ; Female ; Humans ; Immunoglobulin G ; Receptors, Tumor Necrosis Factor ; Recurrence ; Adalimumab ; Infliximab ; Etanercept

BACKGROUNDThe development of new adjuvants for human use has been the focus of attention. This study's aim is to explore the possibility of using nanoparticle Ca nanoparticles (CA) as a vaccine adjuvant of anti-idiotypic antibody NP30 against schistosomiasis and its protective mechanisms.

METHODSNanoparticle CA-NP30 conjugate (CA-NP30) was fabricated. BALB/c mice were immunized actively with CA-NP30 to evaluate its effects of protective immunity on mice. The serum levels of specific IgG, IgG1 and IgG2a antibodies against NP30 and the concentrations of IFN-gamma and IL-4 in supernatant of splenocytes were determined via ELISA.

RESULTSNanoparticle CA could enhance significantly the protective immunity of NP30 against infection of Schistosoma japonicum and the worm reduction rose from 36.0% (NP30 alone) to 52.6%. The serum levels of specific IgG, IgG1 and IgG2a antibodies against NP30 increased remarkably, as compared with those of the group immunized with NP30 alone. The concentration of IFN-gamma in supernatant of splenocyte was drastically elevated [the groups immunized with CA-NP30 and NP30 alone were (493.80 +/- 400.74) pg/ml and (39.03 +/- 39.58) pg/ml, respectively], but the concentration of IL-4 showed no significant difference from that of NP30 alone [(27.94 +/- 9.84) pg/ml vs (27.28 +/- 14.44) pg/ml].

CONCLUSIONSNanoparticle CA could act as a vaccine adjuvant of anti-idiotypic antibody NP30 against schistosomiasis. The mechanism could be that CA-NP30 enhances humoral and cellular immune responses in mice.

Adjuvants, Immunologic ; Animals ; Antibodies, Anti-Idiotypic ; immunology ; Antibodies, Helminth ; immunology ; Mice ; Mice, Inbred BALB C ; Nanotechnology ; Schistosomiasis ; prevention & control ; Vaccines

No abstract available.
Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Arthritis, Psoriatic* ; Adalimumab ; Infliximab

Tumor necrosis factor-alpha antagonists include monoclonal antibodies, infliximab, adalimumab, etanercept and golimumab. Clinical trials of these agents have shown that they are remarkably effective for psoriasis, but cutaneous adverse reactions of these agents including paradoxical aggravation of psoriasiform eruption have been also reported. We present a case of psoriasiform eruption triggered by golimumab therapy in a patient with rheumatoid arthritis. A 53-year-old woman presented with a skin lesion on the sole. She had been treated by golimumab every 4 weeks for rheumatoid arthritis from September 2006. 16 weeks after the treatment, she developed a erythematous and scaly patch on the sole. She had a history of palmoplantar pustulosis, but the skin lesions had not appeared for a long time, recurring when she started golimumab treatment. The skin lesion improved with topical steroid treatment, but as golimumab was re-administrated, the skin lesion exacerbated.
Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Arthritis, Rheumatoid ; Female ; Humans ; Immunoglobulin G ; Middle Aged ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Skin ; Tumor Necrosis Factor-alpha ; Adalimumab ; Infliximab ; Etanercept

Atopic dermatitis (AD) is a chronic cutaneous inflammatory disease. Various categories of therapeutic medications are used for treating AD. Omalizumab is a monoclonal anti-IgE antibody that binds to IgE molecules at the high-affinity receptor (FcepsilonRI) binding site. Therefore, omalizumab can be used as a potential new systemic treatment agent for recalcitrant AD patients with elevated IgE levels. A 34-year-old man had been treated for AD with several topical and oral agents. However, he was refractory to these therapies and his serum IgE levels were very high. We treated him with omalizumab. After 8 months of the treatment, his symptoms were notably improved and the SCORAD index was decreased. Thus, we report on the first case of recalcitrant AD that was successfully treated with omalizumab in Korea.
Adult ; Antibodies, Anti-Idiotypic ; Antibodies, Monoclonal, Humanized ; Binding Sites ; Dermatitis, Atopic ; Humans ; Immunoglobulin E ; Korea ; Omalizumab

Food allergy has increased dramatically in prevalence over the past decade in westernized countries, and is now a major public health problem. Unfortunately for patients with food allergy, there is no effective therapy beyond food allergen avoidance, and rapid medical treatment for accidental exposures. Recently, oral immunotherapy (OIT) has been investigated as a treatment for this problem. In this review, we will discuss the progress in developing OIT for food allergy, including a novel approach utilizing Xolair (anti-IgE monoclonal antibody, omalizumab) in combination with OIT. This combination may enhance both the safety and efficacy of oral immunotherapy, and could lead to a widely available and safe therapy for food allergy.
Antibodies, Anti-Idiotypic ; Antibodies, Monoclonal, Humanized ; Food Hypersensitivity ; Humans ; Immunotherapy ; Prevalence ; Public Health ; Omalizumab