Arthritis Drugs & New Medications-2001 Meeting (cont.)
Churg-Strauss Syndrome patients did equally well if treated with Cytoxan (cyclophosphamide) for 6 or for 12 months.
Dr. Shiel's Perspective: This study suggests that doctors might now be able to recommend a shorter (and, therefore, less toxic) course of Cytoxan for patients with Churg-Strauss Syndrome.
Viagra (sildenafil) seemed to help function in scleroderma patients with severe pulmonary hypertension (elevated blood pressure in the artery to the lungs).
Dr. Shiel's Perspective: Because Viagra has an effect on the smooth muscle of the blood vessels, it was tried in these very ill patients who had failed the traditional prostacyclin intravenous infusions. Although Viagra did show favorable results, these are very small preliminary studies. Incidentally, it might be expected that there would be some benefit on the Raynaud's phenomenon in patients treated with this drug, and that is exactly what the researchers saw in all patients. Further research studies are now needed to really determine the exact role and safety of Viagra in patients with scleroderma.
Erythromycin helped the stomach involvement in scleroderma patients more effectively than the bowel muscle-stimulator drug, metoclopramide.
Dr. Shiel's Perspective: Stomach and bowel muscles can become weakened as a result of scleroderma, thereby resulting in loss of normal function of the bowels. This is a serious condition. In the past, doctors have used bowel muscle-stimulating drugs, such as metoclopramide. Doctors have also used antibiotics (I use tetracycline or erythromycin). The reason for the antibiotics is that the bowel of scleroderma patients can become overgrown with bacteria, which is associated with slowing the bowel function. The antibiotics seem to improve this condition. This study is a head-to-head comparison of the two options. It is encouraging to see that common antibiotics can be beneficial in this condition.
Mouth and genital ulcers in patients with Behcet's disease healed and were reported as less frequent in 9 or 12 patients who were treated with Trental (pentoxifylline).
Dr. Shiel's Perspective: Trental also seemed to maintain the healed ulcers for up to the 29 months of the study. The effectiveness of Trental, the researchers said, seemed to be enhanced by the combination with colchicine in some patients. I felt this paper was significant because, to date, colchicine has been the mainstay of treatment of these often terribly painful sores. Now, it appears that we have other options.
Treatment of polyarteritis nodosa (PAN) that is associated with Hepatitis B with the anti-virus drug lamivudine, along with steroids and plasma exchange (plasmapheresis), can be safe and effective.
Dr. Shiel's Perspective: Traditionally, PAN that is not associated with hepatitis virus infection is treated with high doses of steroids and Cytoxan (cyclophosphamide). Cytoxan can suppress the immune system. Thus, if a patient's PAN is associated with hepatitis infection, the virus infection could worsen with Cytoxan. These researchers reported that removing immune factors in the blood with plasmapheresis combined with antivirus drug (lamivudine) can be beneficial in the situation of Hepatitis B-related PAN. This is very helpful information for doctors and those patients affected by this condition.
Last Editorial Review: 12/3/2001