A systematic review and network meta-analysis of the safety of early interventional treatments in rheumatoid arthritis

Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases

Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug-device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug-device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies.

KW2449 ameliorates collagen-induced arthritis by inhibiting RIPK1-dependent necroptosis

Objective

Necroptosis has recently been found to be associated with the pathogenesis of many autoimmune diseases, including rheumatoid arthritis (RA). This study was undertaken to explore the role of RIPK1-dependent necroptosis in the pathogenesis of RA and the potential new treatment options.

Methods

The plasma levels of receptor-interacting protein kinase 1 (RIPK1) and mixed lineage kinase domain-like pseudokinase (MLKL) in 23 controls and 42 RA patients were detected by ELISA. Collagen-induced arthritis (CIA) rats were treated with KW2449 by gavage for 28 days. Arthritis index score, H&E staining, and Micro-CT analysis were used to evaluate joint inflammation. The levels of RIPK1-dependent necroptosis related proteins and inflammatory cytokines were detected by qRT-PCR, ELISA and Western blot, and the cell death morphology was detected by flow cytometry analysis and high-content imaging analysis.

Results

The plasma levels of RIPK1 and MLKL in RA patients were higher than those in healthy people, and were positively correlated with the severity of RA. KW2449 could reduce joint swelling, joint bone destruction, tissue damage, and the plasma levels of inflammatory cytokines in CIA rats. Lipopolysaccharide combined with zVAD (LZ) could induce necroptosis in RAW 264.7 cells, which could be reduced by KW2449. RIPK1-dependent necroptosis related proteins and inflammatory factors increased after LZ induction and decreased after KW2449 treatment or knockdown of RIPK1.

Conclusion

These findings suggest that the overexpression of RIPK1 is positively correlated with the severity of RA. KW2449, as a small molecule inhibitor targeting RIPK1, has the potential to be a therapeutic strategy for RA treatment by inhibiting RIPK1-dependent necroptosis.

Anticytokine Treatment of Rheumatoid Arthritis: An Observational Report

Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology, characterized by symmetrical arthritis, and deterioration of articular cartilage and epiphyses leading to progressive destruction and deformation of joints, resulting in disability. The purpose of this chapter is to evaluate the effects of treatment with anti-inflammatory biologic medication, Enbrel (Etanercept), during therapeutic rehabilitation in RA patients. The sample comprised 10 hospitalized patients (8 females and 2 males) of the mean age of 32.2 ± 13.4 years treated with Enbrel in 2008-2010. The drug was administered subcutaneously in a dose of 50 mg once a week. Outcomes consisted of differences in the Disease Activity Score (DAS-28) and the degree of joint impairment based on the Health Assessment Questionnaire (HAQ) noted 2 months after treatment onset. The average pre-/post-treatment DAS-28 score was 4.1/2.6, with improvement in 9 patients. The average HAQ score was 1.5/0.6, respectively. We conclude that treatment with Enbrel significantly reduces RA activity and improved joint impairment. The beneficial influence of the drug enabled an earlier commencement of physical rehabilitation, which may have a preventive bearing on the development of disability.