Rheumatoid Arthritis - 2001 National Meeting (cont.)

The long-term safety of Enbrel in more than 2,600 patients over 5 years was reported. There was no cumulative toxicity with extended use and the clinical response was sustained for up to 5 years of the study.

Dr. Shiel's Perspective: These long-term statistics are very helpful for doctors who are assessing the value of this relatively new treatment for rheumatoid arthritis.

Enbrel was found to be safe when used in combination with Kineret (see below).

Dr. Shiel's Perspective: Combination therapy using more than one antirheumatic drug is commonly necessary in the treatment of certain patients with RA. This combination awaits further studies of Kineret before it is used commercially.

Enbrel increases general functioning of patients with RA.

Dr. Shiel's Perspective: This is important for doctors in office practice because we want to help our patients get to their optimal functional status.

Enbrel was found to be effective in patients with juvenile RA.

Dr. Shiel's Perspective: Enbrel is already approved for the use in treating juvenile rheumatoid arthritis that has not responded to other disease-modifying rheumatic drugs.

Arava (leflunomide)

Arava reduces inflammation by suppressing the immune cells responsible for the inflammation. It does this by preventing the formation of DNA and RNA in the immune cells by inhibiting an enzyme (dihydroorotate dehydrogenase) that is necessary for the production of a critical component of DNA and RNA, pyrimidine (a nucleic acid).

Arava plus methotrexate was reported as helpful and safe in patients with RA who had failed treatment with methotrexate alone. Elevations in liver function test were reversible with either a dose reduction or discontinuation of Arava.

Dr. Shiel's Perspective: This is a combination that I have not yet used. Both drugs have similar potential side effects in the liver and bone marrow.

Remicade is frequently given together with weekly methotrexate as this has previously been shown to be helpful in preventing immune reactions to the Remicade. 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 already been using this combination effectively in my practice based on preliminary reports already published.