rheumatoid arthritis
Rheumatoid arthritis trials now operate in a treat-to-target paradigm where clinical remission (DAS28 < 2.6) is the primary goal, and biologics failure triggers a logical sequence of mechanism switching. The JAK inhibitor class (tofacitinib, baricitinib, upadacitinib) has added an oral option after TNF/IL-6 inhibitor failure, though cardiovascular safety signals have reshaped prescribing guidance.
Active trials evaluate next-generation JAK inhibitors with improved selectivity, IL-17A/F bispecifics, TYK2 inhibitors, CAR-T cell therapy for refractory disease, and precision medicine biomarkers (MBDA score, synovial biopsy) to guide treatment selection. Tapering and de-escalation in sustained remission is a growing research priority.