Reports From National Arthritis Meeting 2003
Perspectives of Interest On Arthritis Drugs & New Medications From
2003 Annual Scientific 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 research 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. TNF promotes the inflammation and
its associated fever and signs (pain, tenderness, and swelling) in several
inflammatory conditions, including rheumatoid arthritis.
By blocking the action of TNF-alpha, infliximab reduces the signs and
symptoms of inflammation and stops the progression of joint damage. Remicade is
used to treat rheumatoid arthritis, Crohn's disease, and other serious forms
of inflammation such as uveitis, psoriatic arthritis, and ankylosing
spondylitis. Remicade is given by intravenous infusion over approximately 2
hours, usually every 4-8 weeks.
British
researchers found that Remicade infusions could be safely administered at faster
rates after the first 4 infusions if no reactions were noted in the first
infusions. They also noted that stopping and restarting Remicade as a treatment
did not result in any increase in toxicity.
Dr. Shiel's
Perspective:
Exciting news for
patients already using Remicade. It appears that they may not require the usual
2 hour rate of infusion after taking 4 doses of Remicade without side effects.
Theoretically, Remicade might have the potential to cause sensitization. So that
if Remicade were stopped and restarted at a much later date, there could
be an increased chance of allergic reaction. However according to this
research, if, for whatever reason, Remicade treatment is interrupted, resumption
of the drug at a later time does not come with an increased chance for an
infusion reaction!
Researchers from
the United Kingdom reported that patients whose rheumatoid arthritis is not
controlled with Remicade can respond successfully to Enbrel.
Dr. Shiel's
Perspective:
Well, this is very
interesting. Since both Remicade and Enbrel block TNF as a key method of action,
one might expect that switching from one drug to the other might not be
effective. Wrong. The researchers point out that the reason for the benefit from
switching might be related to the fact that they do differ slightly in their
targets (Remicade binds to both a soluble form of TNF-alpha and to TNF-alpha
bound to membranes of cells, while Enbrel binds to soluble TNF-alpha and to
another chemical messenger lymphotoxin-alpha). Big words! They simply mean that
if one fails on one TNF-blocking drug, it is rational to try another.
Remicade was
reported as safe and effective in psoriasis and ankylosing spondylitis.
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