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Targeting of the inflammatory cytokine TNF-α by biologic agents, such as Adalimumab, has been the most beneficial treatment strategy to date for patients with arthritis [ 9].
In RA patients, a meta-analysis of therapeutic studies showed that inhibiting levels of some pro-inflammatory cytokines by biologic agents such as anti-TNF, anti-IL-6, CTLA4 immunoglobulin or anti-CD20 significantly decreased the level of fatigue whatever the therapy [ 46].
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More recently, biologic agents such as etanercept, infliximab and adalimumab, which act by inhibiting tumour necrosis factor (TNF), have become available.
Therapeutic drug design targeting TNF has led to the emergence of successful biologic agents, such as etanercept, in recent years.
Additionally, not all immunomodulatory drugs currently used to treat uveitis were included in the survey; omitted treatments include the calcineurin inhibitors tacrolimus and sirolimus, the alkylating agent chlorambucil, and newer biologic agents such as golimumab or certolizumab.
Biologic agents such as bevacizumab and erlotinib have been investigated in phase III trials in the first- and second-line setting.
There is a growing interest in the use of biologic agents such as platelet-rich plasma and mesenchymal stem/stromal cells to treat musculoskeletal injuries, including meniscal tears.
Antibody formation can follow the administration of biologic agents such as the TNF antagonists.
Other treatment agents include immunosuppressants, intravenous immunoglobulin, and biologic agents—such as tumor necrosis factor alpha inhibitors [ 16].
However, there are negative aspects to therapy with biologic agents, such as opportunistic infections, infusion reactions, high cost, and the fact that there are some patients in whom RA remains active regardless of the use of biologics.
It is noteworthy in this respect, that many naturally occurring and even biologic agents, such as anti-TNF-α strategies, do not exhibit clear dose-response profiles.
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