Rheumatoid arthritis is a chronic autoimmune disease of the connective tissue of synovial joints. It is characterized by a non-specific symmetrical inflammation of the surrounding joints, which can lead to the progressive destruction of joints and surrounding structures of joints, eventually leading to sports injuries and disability. The incidence of RA increases with age, and women are more susceptible to the disease, which affects approximately 0.3% -1% of the world's population.

Status 

We are both familiar and unfamiliar with RA. The familiarity lies in the fact that almost everyone has heard about it in life. The strangeness is that even the professionals in the field of RA do not know the specific pathogenesis of the disease. It is known that it is usually closely related to infection and inflammation.

Traditional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate can relieve clinical symptoms, but for most patients, it is not enough to effectively prevent the process of joint destruction.

Prior to the emergence of biological products such as TNFα inhibitors, RA patients did not have many medication options and their quality of life was poor.

TNFα inhibitors can quickly relieve symptoms, curb disease progression, and provide new and better options for RA treatment.

The excellent therapeutic effect on RA has made TNFα the most successful target so far, and has achieved a number of star products such as Humira and Enbrel. These drugs have also greatly improved the quality of life for most RA patients.

The relationship between a good drug / target and the patient may be such an interdependence and achievement.

TNFα inhibitor

At present, the FDA has approved 5 biological products targeting TNFα, accounting for about 35% of the global antibody market in 2015.

The success of TNFα inhibitors in the field of RA is self-evident, creating Humira, the king of drugs that has stood up for many years, and two billion-dollar drugs, Enbrel and Remicade.

Abasicept / Rituximab

Compared with the close combat of TNFα inhibitors in the RA field, the killing of CTLA4 and CD20 targets in the RA field is slightly lonely.

Absacept of BMS is a fusion protein composed of CTLA4 extracellular domain linked to Fc of IgG1. It inhibits T cell co-stimulation and inhibits the production of inflammatory factors such as TNFα, IFN-γ, and IL-2, and plays a role in treating RA.

Rituximab is a chimeric antibody that targets the CD20 antigen of B cells, causing B cell depletion, thereby eliminating antibody production. In addition to being widely used to treat non-Hodgkin's lymphoma, rituximab is also used in the field of RA.

Other

RA biologics in the late clinical stages are mainly denosumab and Mavrilimumab of AstraZeneca. Denosumab is a fully human monoclonal antibody targeting RANKL. It has been approved for the treatment of osteoporosis and other diseases, and is currently undergoing phase 3 clinical trials for RA indications. Mavrilimumab is a monoclonal antibody that targets the GM-CSF receptor and is a fisrt-in-class drug. Published data show that Mavrilimumab is effective.

Summary

Driven by TNFα inhibitors, the market for RA therapy in the United States increased from 10.8 billion US dollars in 2010 to 19.7 billion US dollars in 2014, with a compound annual growth rate of 16.2%.

It is estimated that, driven by TNFα inhibitors, IL-6 antibodies, and JAK inhibitors, the RA market in 2019 will reach $ 30.5 billion, and JAK oral inhibitors will occupy 6% of the market.