BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (BDMARDS) IN THE TREATMENT OF RHEUMATOID ARTHRITIS: EFFICACY, SAFETY, AND MODERN APPROACHES

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease in which biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs/tsDMARDs) have become an integral stage of care when conventional synthetic DMARDs (csDMARDs), primarily methotrexate, fail to achieve adequate control. These agents act at defined points in the immunopathogenic cascade, reducing disease activity and preventing structural damage.

Methods: This narrative review synthesizes current evidence on the mechanisms of action, clinical efficacy, safety profile, and modern selection strategies for bDMARDs/tsDMARDs, drawing on the 2022/2023 EULAR recommendations and major randomized controlled trials.

Results: TNF inhibitors, IL-6 receptor inhibitors, the T-cell costimulation blocker abatacept, the B-cell depleting agent rituximab, and JAK inhibitors act at distinct points in the immune cascade and produce comparable ACR20/50/70 response rates. Safety profiles differ by class: infection risk is common to all bDMARDs, while JAK inhibitors carry particular concern for venous thromboembolism and cardiovascular risk, IL-6 inhibitors for gastrointestinal perforation and lipid changes, and rituximab for hepatitis B reactivation. Modern practice emphasizes individualized selection based on comorbidities, cost reduction through the availability of biosimilars, and gradual dose tapering once sustained remission is achieved.

Conclusion: Biologic and targeted synthetic DMARDs represent a qualitative advance in RA treatment, but their safe and effective use requires thorough screening, regular monitoring, and individualized patient selection — an approach that, with the expanding availability of biosimilars, is increasingly feasible even in resource-constrained systems such as Uzbekistan's.