DOCTOR'S VIEW ARCHIVE

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.

Dr. Shiel's Perspective: Actually, rheumatologist have been using the drug for these patients for some time because of other preliminary positive reports in these conditions. It is good to have the support of this further long-term follow-up research.

Remicade was effective in treating sarcoidosis of the lungs and its accompanying toxic levels of calcium.

Dr. Shiel's Perspective: Other reports of Remicade treatment of sarcoidosis are supported by this report. Remicade seems to have beneficial effects in many diseases that feature microscopic areas of tissue inflammation called granulomas. These diseases include Crohn's disease, Wegener's granulomatosis, and sarcoidosis.



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