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

Researchers from Germany reported that Humira is effective and safe for at least 6 years of study.

Dr. Shiel's Perspective: This report is encouraging as we are now accumulating more and more longterm data that suggests that the effectiveness of the drug is sustained.

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 rheumatoid arthritis.

Dr. Shiel's Perspective: Rituxan would represent a novel approach as a treatment alternative in rheumatoid arthritis. This report is one of many suggesting that Rituxan may offer an alternative in treating rheumatoid arthritis. An interesting aspect of this reports treatment is that in the 2 years of the study, patients received Rituxan infusion only on days 1 and 15 they did fine without further infusions for the 2 year period while continuing with methotrexate treatment. It is not yet clear which patients would be the best candidates for Rituxan treatment.


Abatacept is a potential new treatment for rheumatoid arthritis on the horizon. It is unique in its method of action, which involves blocking the function of specialized immune cells called T-cells. Abatacept is given by intravenous infusion.

Abatacept was reported as effective and safe in treating patients with rheumatoid arthritis who had failed treatment with Remicade or Enbrel. Another paper reported that abatacept was effective in decreasing signs and symptoms of rheumatoid arthritis in patients failing methotrexate.

Dr. Shiel's Perspective: Abatacept may be a viable option in the near future for those patients who do not respond to Humira, Remicade, or Enbrel. Importantly, abatacept halted erosion of joints in the patients studied.


Etoricoxib (Arcoxia) is a Cox-2 inhibitor that is used in Europe and elsewhere to reduce pain and inflammation of arthritis.

Etoricoxib (Arcoxia) was presented in 4 studies at the national meeting and shown to be safe and effective in treating gout, osteoarthritis, and ankylosing spondylitis.

Dr. Shiel's Perspective: This drug is somewhat related to Vioxx, another Cox-2 inhibitor that was withdrawn from the market by Merck because of heart attack and stroke side effects. Etoricoxib (Arcoxia) is awaiting approval for use in the U.S., and while its maker notes that it has been shown to be safe, I believe it will undergo serious scrutiny of longer term studies prior to approval for the U.S. market. The drug is clearly effective for the inflammation of arthritis.

Gout Treatments

Several research centers reported on a new drug for treating the elevated levels of uric acid that lead to gout. This drug, febuxostat (Uloric), produced by TAP pharmaceuticals, can be used in persons who are allergic to allopurinol.

Dr. Shiel's Perspective: This is exciting news for the gout field. Rash allergic reactions to allopurinol do occur and this drug will provide a viable option in this setting. This is also important news for patients with kidney disease who have elevated blood levels of uric acid or gout because the drug is metabolized by the liver and not the kidneys like the traditional gout drug allopurinol. (Febuxostat) is not yet on the market in the U.S., but will likely be approved for use soon.

Etoricoxib (Arcoxia) is a new Cox-2 antiinflammation medication that can be effective in treating the acute attacks of gout.

Dr. Shiel's Perspective: We need more options in the treatment of arthritis attacks in gout patients. This drug is somewhat related to Vioxx, another Cox-2 inhibitor that was withdrawn from the market by Merck because of heart attack and stroke side effects. As a result, Arcoxia will likely be required to undergo significant further study before being released in the U.S. (It is already being used outside of the U.S.)

Fibromyalgia Treatment

Duloxetine (Cymbalta) was shown by researchers at the University of Cincinnati to be effective and safe in treating fibromyalgia.

Dr. Shiel's Perspective: This one could be big. Cymbalta has been demonstrated by previous studies to be effective in relieving pain from nerve diseases. Early studies had suggested its potential as a treatment for fibromyalgia. It is classified as an antidepression medication. It is a potent inhibitor of the brain chemicals serotonin and norepinephrine. Interestingly, in this study, it worked whether or not the patients with fibromyalgia had depression.

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Last Editorial Review: 4/7/2005