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Table 1 Biologic DMARDs for the treatment of RAa

From: Evaluating the efficacy of sequential biologic therapies for rheumatoid arthritis patients with an inadequate response to tumor necrosis factor-α inhibitors

Generic drug name (brand name, year of FDA approval) Structure and mechanism of action Mode and frequency of administration
TNF-α inhibitors   
   Infliximab (Remicade, 1999) Chimeric monoclonal antibody that binds to TNF-α and blocks its interaction with cell surface receptors Intravenous infusion every 8 weeks
   Etanercept (Enbrel, 1998) Soluble human fusion recombinant protein that binds to TNF-α and blocks its interaction with cell surface receptors Subcutaneous injection weekly or twice weekly
   Adalimumab (Humira, 2002) Recombinant human monoclonal antibody that binds to TNF-α and blocks its interaction with cell surface receptors Subcutaneous injection every 2 weeks (or weekly if methotrexate is not taken concurrently)
   Golimumab (Simponi, 2009) Human monoclonal antibody that binds to TNF-α and blocks its interaction with cell surface receptors Subcutaneous injection monthly
   Certolizumab pegol (Cimzia, 2009) Recombinant, humanized, pegylated Fab' of a monoclonal antibody that binds to TNF-α and blocks its interaction with cell surface receptors Subcutaneous injection every 2 or 4 weeks, if dosed at 200 mg or 400 mg, respectively.
Other biologic DMARDs   
   Abatacept (Orencia, 2005) Soluble fusion protein that inhibits the costimulation of T-cells Intravenous infusion every 4 weeks
   Anakinra (Kineret, 2001) Recombinant IL-1 receptor antagonist that inhibits the binding of IL-1 to its receptor, thereby allowing regulation of IL-1 activity Subcutaneous injection daily
   Rituximab (Rituxan, 2006) Chimeric monoclonal antibody that binds to the cell surface protein CD20 and selectively depletes B-cells. Intravenous infusion: two infusions separated by 2 weeks every 24 weeks or based on clinical evaluation
   Tocilizumab (Actemra, 2010) Humanized IL-6 receptor that inhibits the binding of IL-6 to its receptor, preventing IL-6 signal transduction Intravenous infusion every 4 weeks
  1. aDMARDs, disease-modifying antirheumatic drugs; Fab', fragment antigen-binding region; RA, rheumatoid arthritis; FDA, Food and Drug Administration; TNF, tumor necrosis factor; IL, interleukin.