Rheumatoid Arthritis - 2001 National Meeting (cont.)
Remicade was also effective for treating juvenile rheumatoid arthritis, thereby resulting in a significant and prompt reduction in disease activity and improved quality of life. And, another paper presented data demonstrating that doses of Remicade that are higher than currently recommended doses could be effective and necessary in juvenile rheumatoid arthritis.
Dr. Shiel's Perspective: This does not surprise me, since it is the same situation for adults with RA.
Remicade treatment allowed for the reduction in the use of simultaneous arthritis medications over time in 40% of patients. In fact, in many instances, patients were able to fully withdraw from other medications to the use of Remicade alone. This included tapering completely off of steroids (such as prednisone) and methotrexate.
Dr. Shiel's Perspective: I have been lowering doses of methotrexate and weaning off of steroids in my patients that have stable disease.
Remicade was reported as safe in 2 patients with RA who also had chronic hepatitis C.
Dr. Shiel's Perspective: I have treated patients with both conditions, but not yet with Remicade. This is may be a reasonable option for certain patients.
Remicade is frequently given together with weekly methotrexate, since this has previously been shown to be helpful in preventing immune reactions to the Remicade. Research was presented that demonstrated the safety and effectiveness of Remicade alone. Also, at this meeting, papers were presented that demonstrated the safety and effectiveness of Arava in combination with Remicade as an alternative to methotrexate/Remicade combination in the treatment of RA.
Dr. Shiel's Perspective: I have treated patients with the Arava/Remicade combination successfully after hearing of previous preliminary reports. It is a treatment option for certain patients, such as those who could not tolerate methotrexate.
Both increasing the dose of Remicade and decreasing the interval between infusions were shown to be effective methods in capturing control of RA in several studies.
Dr. Shiel's Perspective: This is something I have already been doing in practice for the past 2 years. While it does not always work for those resistant cases, it can be very effective.
If Remicade is stopped, it was reported to result in a flare of the RA in an average of 4 months in 2/3 of patients.
Dr. Shiel's Perspective: This makes complete sense since Remicade is basically a powerful antiinflammation drug that only works when it is blocking the inflammation promoting protein, tumor necrosis factor (TNF). When it is out of the system, eventually the inflammation of the RA should return--(and does, on the average of about 4 months, as was shown at this meeting).