Arthritis Drugs & New Medications-2001 Meeting (cont.)
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 the methotrexate/Remicade combination in the treatment of rheumatoid arthritis.
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 rheumatoid arthritis 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 rheumatoid arthritis 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 rheumatoid arthritis should return--(and does, on the average of about 4 months, as was shown at this meeting).
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 seems to have a preventative effect against infusion reactions, but the researchers I spoke with were really not certain as to why this happened.