Biologic therapies in non-rheumatic diseases: lessons for rheumatologists?

• Published in: Nature reviews. Rheumatology Vol. 7; no. 9; pp. 507 - 516
• Main Authors: Reynolds, Gary, Isaacs, John D, Bell, Gillian M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2011; Nature Publishing Group
• Subjects: 631/250/249/1313; 631/250/249/2510; 692/699/1670/498; 692/700/565/1331; Asthma; Asthma - immunology; Asthma - therapy; Autoimmunity - immunology; Biological markers; Biological Therapy; Care and treatment; Diabetes; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 1 - therapy; Drug dosages; Health aspects; Humans; Immune Tolerance - drug effects; Infliximab; Medical education; Medicine; Medicine & Public Health; Multiple sclerosis; Multiple Sclerosis - immunology; Multiple Sclerosis - therapy; Practice; Psoriasis; Psoriasis - immunology; Psoriasis - therapy; review-article; Rheumatic diseases; Rheumatic Diseases - immunology; Rheumatic Diseases - therapy; Rheumatology; Rheumatology - methods; Tumor necrosis factor
• ISSN: 1759-4790; 1759-4804
• DOI: 10.1038/nrrheum.2011.106

The use of biologic agents has revolutionized treatment in a number of rheumatic and non-rheumatic autoimmune and inflammatory disorders. In this Review, the authors discuss whether rheumatologists can learn lessons from the application of biologic agents in non-rheumatic diseases such as psoriasis, asthma and multiple sclerosis. Biologic therapies have been licensed to treat rheumatic diseases for more than a decade. In parallel, they have gained acceptance in a variety of non-rheumatic diseases, where their impact has been no less revolutionary. In this Review, we examine the application of biologics in a number of non-rheumatic autoimmune and inflammatory disorders—psoriasis, inflammatory bowel disease, uveitis, asthma, diabetes, congestive cardiac failure and multiple sclerosis. In particular, we have sought information, or lessons, that could influence their application in rheumatic diseases. For example, we highlight the potential to stratify asthma into groups that might require different targeted approaches, and focus on some of the less common adverse events associated with biologic therapies in multiple sclerosis. Similarly, we examine type 1 diabetes mellitus in the context of potential therapeutic induction of immune tolerance. Working collaboratively, across specialties, there is significant synergy to be gained in regard to understanding how biologic therapies work, how best to use them, and the adverse effects we should be conscious of. Key Points Biologic therapies are increasingly used in non-rheumatic diseases As in rheumatic disease, biologics might provide a therapeutic option for otherwise refractory non-rheumatic disease These agents may also provide proof-of-concept for proposed mechanisms of immunopathology, such as IL-1β blockade in type 2 diabetes mellitus In other situations their effects can be paradoxical, such as worsening of heart failure and occasional induction of psoriasis and uveitis during tumor necrosis factor blockade