Arthritis Drugs and New Meds: 2004 Perspectives (cont.)

Remicade was effective in treating sarcoidosis of the lungs and Behcet's disease.

Dr. Shiel's Perspective: Other reports of Remicade treatment of sarcoidosis and Behcet's disease 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.

Remicade was also reported to increase work productivity and decrease time lost from work in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Part of overall health is function. This and other studies are reassuring in that the ultimate goals are being met for patients with serious forms of arthritis with aggressive treatments.

Enbrel and Remicade were reported effective in treating ankylosing spondylitis as manifest by improvements in spinal MRI testing.

Dr. Shiel's Perspective: Enbrel has been approved for ankylosing spondylitis treatment within the past year. Remicade will be soon.

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 (next 2 months). Also, the new form of Enbrel will not require mixing powdered drug with sterile liquid as it is already premixed in a liquid solution! Obviously, far more convenient for patients using Enbrel.

Researchers again reported at this meeting, similar to last year, 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 7 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!

Enbrel for ankylosing spondylitis was reported to have sustained benefit and safety for at least 24 months.

Dr. Shiel's Perspective: Enbrel appears to be a safe and effective treatment for ankylosing spondylitis. The only reason it is only 2 years is because that is how long the study has been running at this point.

Enbrel and Remicade were reported effective in treating ankylosing spondylitis as manifest by improvements in spinal MRI testing.

Dr. Shiel's Perspective: Enbrel has been approved for ankylosing spondylitis treatment within the past year. Remicade will be soon.

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.

In a study of 799 patients, researchers from a number of centers reported that Humira combined with methotrexate was extremely effective, and more effective than either drug alone, in treating very early rheumatoid arthritis.

Dr. Shiel's Perspective: This work is important for several reasons. We are finding that if we can turn off rheumatoid arthritis quickly and early we have a better chance of ultimately stopping the disease. Moreover, it seems that if we hit rheumatoid arthritis hard (such as with the combination of drugs as above), we significantly increase the chances of stopping the disease.

Humira was reported as effective in treating patients with rheumatoid arthritis who had already failed to improve with other biologic medications, such as Enbrel, Remicade, and Kineret.

Dr. Shiel's Perspective: These reports are welcome news for patients with rheumatoid arthritis. We need to have options available when we do not get the expected results from medications we use. It is interesting that Humira can work even when biologic medications that act similarly (Enbrel and Remicade) are not effective.