Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Arthritis Drugs & New Medications From 2001 Annual Scientific Meeting Of The American College Of Rheumatology

Below are perspectives on key reports presented at the recent national meeting of the American College of Rheumatology:

Introduction

Scientists throughout the world are studying many promising areas of new treatment approaches for arthritis and rheumatic diseases. These areas include monoclonal antibody therapy that is directed against a special inflammation factor called the tumor necrosis factor (TNFalpha) (as described below regarding Remicade and Enbrel), and new TNF human antibodies. Also, new non-steroidal antiinflammatory drugs (NSAIDs), with mechanisms of action that are different from current drugs, are on the horizon. Genetic research and engineering are also likely to bring forth many new avenues of earlier diagnosis and treatment in the near future.

Below are perspectives on key reports presented at the recent national meeting of the American College of Rheumatology:

REMICADE (infliximab)

Remicade (infliximab) is an antibody that blocks the effects of tumor necrosis factor alpha (TNF-alpha). TNF-alpha is a substance made by cells of the body that has an important role in promoting inflammation. By blocking the action of TNF-alpha, infliximab reduces the signs and symptoms of inflammation.

Remicade was a topic in over 100 papers presented at the meeting, most of which related to rheumatoid arthritis. Remicade, an approved treatment for rheumatoid arthritis, is given by intravenous infusion every 2 months.

Researchers at this meeting reported Remicade to be effective and safe in treating rheumatoid arthritis. Some reported an 80% significant response rate in the first year of use.

Dr. Shiel's Perspective: This is my experience with this medication, which is very effective in calming the pain, stiffness, and swelling from the inflammation due to arthritis in a high percentage of patients.

It was also reported by researchers from the Netherlands that a combination of Remicade/methotrexate prevents structural damage to the joints of patients with rheumatoid arthritis, regardless of whether or not the patient was feeling better!

Dr. Shiel's Perspective: The fact that blocking TNF with drugs like Remicade and Enbrel stops disease progression has already been shown. The interesting point of this study is that they seem to prevent joint damage irrespective of whether patients' signs and symptoms of arthritis were improving. This seems to imply that the drug has an essential effect in stopping the rheumatoid disease.

Remicade or Enbrel treatments resulted in the increased ability of patients to work.

Dr. Shiel's Perspective: While it seems patently logical that controlling a disease that results in loss of function would help people return to the work place, it is good to see it documented.

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. 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 rheumatoid arthritis.

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.