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Immune-mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution

Rheumatology Research Unit, Addenbrooke’s Hospital, Cambridge, UK

Correspondence to:
Correspondence to:
Dr A J K Östör
Rheumatology Research Unit, Box 194, E6, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK; andrew.ostor{at}addenbrookes.nhs.uk

Targeted biologic therapies have revolutionised treatment of immune-mediated inflammatory diseases (IMIDs) due to their efficacy, speed of onset and tolerability. The discovery that clinically unrelated conditions, such as rheumatoid arthritis and Crohn’s disease, share similar immune dysregulation has led to a shift in the management of IMIDs from one of organ-based symptom relief to mechanism-based treatment. The fact that anticytokine therapy has been effective in treating multiple orphan inflammatory conditions confirms the IMID paradigm. In this review we examine the biologic agents currently licensed for use in the US and Europe: infliximab, etanercept, adalimumab, rituximab, abatacept, anakinra, alefacept and efalizumab. We also discuss the rationale behind the management of IMIDs using rheumatoid arthritis, Crohn’s disease, psoriasis and psoriatic arthritis as examples. For the medical profession, IMID represents a breakthrough in the way pathology is classified. In this burgeoning era of biologic therapy the prospect of complete disease remission is conceivable.

Abbreviations: ACR, American College of Rheumatology; ANA, antinuclear antibodies; AS, ankylosing spondylitis; CD, Crohn’s disease; CTLA4, cytotoxic T lymphocyte antigen-4; DMARDs, disease modifying anti-rheumatic drugs; EMEA, European Medicines Agency; FDA, US Food and Drug Administration; IL1, interleukin 1; IL6, interleukin 6; IL10, interleukin 10; IMID, immune-mediated inflammatory disease; JIA, juvenile idiopathic arthritis; MTX, methotrexate; NICE, National Institute for Health and Clinical Excellence; PEG, polyethylene glycol; PsA, psoriatic arthritis; QoL, quality of life; RA, rheumatoid arthritis; RCT, randomised controlled trial; TB, tuberculosis; TNF, tumour necrosis factor-; UC, ulcerative colitis

Keywords: anti-TNF; autoimmune disease; biologics; immune-mediated inflammatory disease; rheumatoid arthritis

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