Rheumatoid Arthritis - 2001 National Meeting (cont.)

Three papers reported reactions to the Remicade infusions at rates of 4.3%, 5.5%, and 5.7%. They were generally reported between the second and fifth infusions of Remicade.

Dr. Shiel's Perspective: This is in line with previous reports and seems to be the most significant of the reactions to Remicade. These can often be prevented or minimized by pretreatment with antihistamine drugs and/or cortisone injections. Aspirin use also seem to have a preventative effect against infusion reactions, but the researchers I spoke with were really not certain as to why this happened.

Patients taking Remicade developed DNA antibodies (known to be associated with lupus) in 16% of patients. These antibodies were not felt to significant as they were not related to the development of lupus disease.

Dr. Shiel's Perspective: This has been my experience. I have been monitoring my patients closely for signs of lupus, but have never had any develop it. In fact, I have used Remicade in a number of patients who's conditions were originally lupus, but who transitioned into classical RA without lupus features. None of those patients again developed lupus symptoms and their RA was controlled.

Remicade also was shown to be effective in patients who had previously tried and failed Enbrel. One study reported Remicade and Enbrel as equally effective.

Dr. Shiel's Perspective: I have had some successes here as well. I have also had successes using Enbrel in patients who had failed Remicade. I agree that both drugs are similarly effective.

Enbrel (etanercept)

Enbrel is an injectable anti-tumor necrosis factor for treating rheumatoid arthritis. Tumor necrosis factor (TNF) is a protein that the body produces during the inflammatory response, the body's reaction to injury. TNF promotes the inflammation and its associated fever and signs (pain, tenderness, and swelling) in several inflammatory conditions, including rheumatoid arthritis. Enbrel is a synthetic (man-made) protein that binds to TNF. Enbrel thereby acts like a sponge to remove most of the TNF molecules from the joints and blood. This prevents TNF from promoting inflammation and the fever, pain, tenderness, and swelling of joints in patients with RA.

Enbrel plus methotrexate was reported at this meeting to be more effective than Enbrel alone.

Dr. Shiel's Perspective: This may be true, to a degree, for both Enbrel and Remicade, but I use them individually or with methotrexate or other drugs on a case by case basis.