Unit for Clinical Therapy Research, Inflammatory Diseases, The Karolinska Institute, Karolinska University Hospital, S-171 76 Stockholm, Sweden.
Nat Rev Rheumatol. 2011 Apr;7(4):205-15. doi: 10.1038/nrrheum.2011.22. Epub 2011 Mar 8.
The advent of biologic therapies for the treatment of rheumatoid arthritis (RA) has radically changed this therapeutic area. The currently available biologic agents have been studied extensively as part of their development and also during their subsequent years of use in clinical practice; as a result, the knowledge base regarding these therapeutics is very large. Nonetheless, a number of important questions remain and some key issues are still incompletely understood. In this Review, I discuss a number of these unresolved issues, including: the correct placement of biologic therapies in the long-term evolution of the RA disease process, and the expectations associated with such use; comparisons of therapeutic strategies that include conventional as well as biologic agents; optimal dosing of biologic agents; the elusive goal of personalized therapy; and an appraisal of the real impact of biologic therapy on patients' lives. It is concluded that, despite these unresolved issues, important progress has been made and many additional advances in our understanding can be expected during the coming years.
生物疗法治疗类风湿关节炎（RA）的出现彻底改变了这一治疗领域。目前可用的生物制剂在开发过程中以及随后在临床实践中的使用过程中都进行了广泛研究；因此，关于这些治疗方法的知识库非常庞大。尽管如此，仍有一些重要问题悬而未决，一些关键问题仍未完全理解。在这篇综述中，我讨论了其中一些未解决的问题，包括：生物疗法在 RA 疾病过程的长期演变中的正确定位，以及与之相关的使用预期；包括传统药物和生物制剂在内的治疗策略的比较；生物制剂的最佳剂量；难以捉摸的个体化治疗目标；以及对生物治疗对患者生活实际影响的评估。结论是，尽管存在这些未解决的问题，但已经取得了重要进展，并且在未来几年内可以预期在我们的理解方面会有更多的进展。
