Arthritis Drugs & New Medications-2001 Meeting (cont.)
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 seems 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 be 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 of them develop it. In fact, I have used Remicade in a number of patients whose condition was originally lupus, but transitioned into classical rheumatoid arthritis without lupus features. None of those patients again developed lupus symptoms and their rheumatoid arthritis 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 being 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.
Remicade was reported as effective for treating psoriatic arthritis and ankylosing spondylitis. For those with psoriasis, Remicade not only helped the arthritis, but also helped to clear the psoriasis, often dramatically. A number of papers not only documented the effectiveness and safety of Remicade, but also showed how it gets prompt results and improved the quality of life for these patients.
Dr. Shiel's Perspective: This is a welcome addition to treatment options that have been sorely lacking for these diseases. (I have actually been treating patients with these diseases very effectively with Remicade for some time now based on preliminary data reported at previous meetings.)
Remicade was found to be effective in much higher than the recommended doses.
Dr. Shiel's Perspective: This is similar to findings in patients with rheumatoid arthritis. That is, many times we must increase the doses above the starting doses to obtain the best results.
Remicade was also reported as effective in treating psoriasis and psoriatic arthritis in patients who had previously failed methotrexate or Enbrel.