Emerging treatments

RNA sequencing-based stratification of synovial tissue

Tocilizumab appears to be more effective than rituximab (which targets CD20 B cells) in patients classified as B-cell poor using RNA sequencing, but not in patients histologically classified as B-cell poor.[177] These results suggest that RNA sequencing-based stratification of rheumatoid arthritis (RA) synovial tissue is more strongly associated with clinical response than histopathological classification; further research is required before treatment recommendations can be made. 

Olokizumab

Olokizumab, an investigational humanised monoclonal antibody targeting interleukin-6, in combination with methotrexate has been demonstrated to significantly improve the percentage of people with RA achieving ACR20/50/70, DSA28-CRP, CDAI and HAQ-DI response at 12 weeks compared with placebo.[178][179][180]​ Treatment-related adverse effects were significantly higher in the olokizumab group compared with the placebo group, but serious treatment-related adverse effects did not differ significantly between the olokizumab group and the placebo group.[180]​ Further large randomised controlled trials are needed to establish long term effects.[179]​​

Peficitinib

Peficitinib, an investigational Janus kinase inhibitor, has been found to significantly increase the ACR20/50/70 response rate for people with RA compared with placebo using direct and indirect comparison meta-analysis.[181] An additional indirect comparison meta-analysis concluded that peficitinib is one of the most effective treatments for people with RA with an inadequate response to disease-modifying anti-rheumatic drugs (DMARDs).​[182] Results from one subsequent double blind phase 3 study suggests that peficitinib significantly increases the ACR20 response rate in Asian people with RA who have an inadequate response or intolerance to methotrexate compared with placebo.[183]​​

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