Arthritis: Reports from 2003 Arthritis Meeting (cont.)

Remicade was also reported to be effective in juvenile ankylosing spondylitis.

Dr. Shiel's Perspective: Welcome news for this painful form of arthritis in children.

Enbrel (etanercept)

Enbrel is an injectable blocker of tumor necrosis factor for treating rheumatoid arthritis and psoriatic arthritis. Tumor necrosis factor (TNF) is a protein that the body produces during the inflammatory response, which is the body's reaction to injury. TNF promotes the inflammation and its associated fever and signs (pain, tenderness, and swelling) in several inflammatory conditions, including rheumatoid arthritis. Enbrel is a synthetic (man-made) protein that binds to TNF. Enbrel thereby acts like a sponge to remove most of the TNF molecules from the joints and blood. This prevents TNF from promoting inflammation and the fever, pain, tenderness, and swelling of joints in patients with rheumatoid arthritis (and apparently other forms of inflammatory arthritis, such as psoriatic arthritis, ankylosing spondylitis, and juvenile arthritis-see below). Enbrel is given by subcutaneous injection with a needle and syringe twice weekly.

Enbrel was found to be effective in a once weekly, 50 mg, dose!

Dr. Shiel's Perspective: This is big news. Enbrel is now given by two 25 mg doses each week. Look for once weekly 50 mg dosing soon. Obviously, far more convenient for patients using Enbrel.

Several reports noted the safety and effectiveness of Enbrel for treating patients with psoriatic arthritis.

Dr. Shiel's Perspective: Enbrel has been granted FDA approval for psoriatic arthritis this year because of previous reports that had similar results.

Enbrel was reported effective in treating ankylosing spondylitis.

Dr. Shiel's Perspective: Look for FDA approval for this purpose soon.

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.

Enbrel for rheumatoid arthritis was reported to have sustained benefit and safety after 5 years of treatment.

Dr. Shiel's Perspective: Great news to have long-term data that supports the concept that this drug actually safely stops rheumatoid arthritis in its tracks!

Humira (adalimumab)

Humira (adalimumab) 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, adalimumab reduces the signs and symptoms of inflammation and stops the progression of joint damage. Humira is given by subcutaneous injection with a needle and syringe weekly or every other week.

Researchers from Los Angeles, Boston, San Diego, and Germany reported that the reduction of joint inflammation and improved function from Humira is often extremely rapid (as early as 1 week after starting treatment).

Dr. Shiel's Perspective: This report is consistent with the remarkable benefits in relieving joint swelling, pain, and stiffness that we often see with TNF-blocking drugs, such as Humira.

Several research groups reported that the beneficial effect Humira in quieting inflammation and stopping disease progression of rheumatoid arthritis was sustained over 5 years of study.

Dr. Shiel's Perspective: These reports are welcome news for patients with rheumatoid arthritis. It is reassuring that the initial, often dramatic, effect at stopping inflammation continues over years of treatment. It is very important to have these types of studies with newer medications.

Researchers from Germany reported that Humira is effective when used alone or in combination with methotrexate and that the blood levels of Humira are somewhat higher in patients taking methotrexate as well.

Dr. Shiel's Perspective: This report confirms what has been appreciated by rheumatologists for some time - that the benefits can be enhanced by combining methotrexate with TNF-blocking drugs. It also alludes to one explanation as to why, i.e., because blood levels of Humira are increased when taking it with methotrexate.

Rituxan (rituximab)

Rituxan (rituximab) is an antibody that is used to treat lymphoma, cancer of the lymph nodes. It seems to be effective in treating autoimmune diseases like rheumatoid arthritis because it depletes B-cells, which are important cells of inflammation and in producing antibodies.

Rituxan was found to be beneficial in treating severe rheumatoid arthritis complicated by blood vessel inflammation (vasculitis) and cryoglobulinemia.

Dr. Shiel's Perspective: This report is one of many suggesting that Rituxan may offer an alternative in treating severe complications of rheumatoid arthritis. Rituxan would represent a novel approach as a treatment alternative in rheumatoid arthritis. (Incidentally, another paper at the meeting documented its safety in treating rheumatoid arthritis.)



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