Arthritis Drugs & New Medications-2001 Meeting (cont.)

Dr. Shiel's Perspective: Well, this actually was a significant study because it demonstrated the beneficial effects of Kineret in reducing inflammation in the joints when used in combination with other arthritis medications, such as methotrexate.

The rate of side effects of Kineret was only slightly increased in regard to serious infections in comparison with the placebo.

Dr. Shiel's Perspective: I would like to see further side effect studies with this treatment. Preliminarily, these results are very encouraging.

ADALIMUMAB

This is a new drug that is not commercially available. Adalimumab (D2E7) is the first fully human, monoclonal antibody in development. Adalimumab is an investigational agent designed to block the activity of tumor necrosis factor alpha (TNF-a), which contributes to the inflammation in autoimmune diseases, such as rheumatoid arthritis. This drug, which is given by subcutaneous injection every 2 weeks, was effective in combination with methotrexate and seems to be well tolerated other than occasional injection site reactions. It is not yet commercially available, but is worth keeping an eye on.

Dr. Shiel's Perspective: Well, here comes a new kid on the block. It will be important to watch for further research on this drug. It may well be an effective addition to our current treatments. Injecting only every 2 weeks would be relatively convenient.

VALDECOXIB

Valdecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that is being studied for use in the treatment of rheumatoid arthritis. It is not yet commercially available. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis, which causes pain, fever, swelling, and tenderness. Valdecoxib blocks the enzyme that makes prostaglandins (specifically, cyclooxygenase 2 or Cox-2), thereby resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling, and tenderness are reduced. Cox-2 Inhibitors differ from traditional NSAIDs in that they cause less inflammation and ulceration of the stomach and intestine and do not interfere with the clotting of blood.

Valdecoxib was superior to the placebo and similar to naproxen (at 500mg twice daily) in effectiveness. At the lower doses, it showed less stomach irritation than Naprosyn.

Dr. Shiel's Perspective: This would be a welcome addition to Celebrex, which is the Cox-2 NSAID currently available for the treatment of rheumatoid arthritis.

Valdecoxib was shown to be beneficial in treating osteoarthritis of the hip.

Dr. Shiel's Perspective: This drug may be an additional Cox-2 on the menu in the near future.

ETORICOXIB

Etoricoxib is another Cox-2 NSAID that is being investigated for the treatment of rheumatoid arthritis (see Valdecoxib above). Previous studies have demonstrated this drug's effectiveness in relieving the signs and symptoms of joint inflammation.

Fewer patients treated with etoricoxib had to discontinue the medication because of gastrointestinal complications as compared with the traditional NSAIDs, Voltaren, and Naprosyn.

Dr. Shiel's Perspective: This is an example of a safety study that must be performed before a drug is approved to demonstrate its value. Because it is billed as a Cox-2 inhibitor, etoricoxib should, and apparently does, have advantages with regard to the stomach and intestines.

The experimental drug, Etoricoxib, was shown to be effective in the treatment of osteoarthritis of the knee and hip in over 200 patients.

Dr. Shiel's Perspective: This drug also may be an additional Cox-2 on the menu in the near future.

Fewer patients treated with etoricoxib had to discontinue the medication because of gastrointestinal complications as compared with the traditional NSAIDs, Voltaren, and Naprosyn.

Dr. Shiel's Perspective: This is an example of a safety study that must be performed before a drug is approved to demonstrate its value. Because it is billed as a Cox-2 inhibitor, etoricoxib should, and apparently does, have advantages with regard to the stomach and intestines.

GLUCOSAMINE

Glucosamine is a food supplement that is being used to treat the symptoms of osteoarthritis.

Glucosamine (in a radioactive form that could be identified in tissues) taken by mouth was found to be incorporated into the cartilage of Beagle dogs.

Dr. Shiel's Perspective: This study implies that glucosamine supplements taken by mouth actually can become bioavailable to the cartilage of the joints. Perhaps this will be shown to not only provide some relief of symptoms (already reported in some patients), but it may also be shown in future studies to protect the joints affected by osteoarthritis (being looked into at the NIH).

COMPLEMENTARY & ALTERNATIVE MEDICINES

Complementary and alternative medicines are being used by 33% of osteoarthritis patients. It was also shown that these patients seem to be more cautious about their health and seek specialists' care more commonly.

Dr. Shiel's Perspective: As a practicing rheumatologist for two decades, this is not really news. I frankly believe that this study grossly underestimates the number of persons using complementary and alternative medicines. It does, however, highlight the need for doctor-patient communication with regard to all manners of treatment.



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