Magazine article Drug Topics

New Choices Now Available for Rheumatoid and Osteoarthritis

Magazine article Drug Topics

New Choices Now Available for Rheumatoid and Osteoarthritis

Article excerpt

New ways of treating rheumatoid arthritis offer promise for keeping this serious disease at bay or even reversing cartilage and bone erosions-sometimes in combination with older drugs.

In addition to Remicade (infliximab, Centocor), recently approved for a new indication of rheumatoid arthritis (see story, page 35), reports at the annual meeting in Boston of the American College of Rheumatology shed more light on some recently approved drugs. These include Enbrel (etanercept, Immunex and WyethAyerst) and Arava (leflunomide, Hoechst Marion Roussel).

Reports also addressed the investigational interleukin-1 receptor antagonist Kineret (anakinra, IL-1a, Amgen). This drug appears to improve response when combined with methotrexate, the gold-standard drug for rheumatoid arthritis.

Barbara Finck, M.D., medical director for Immmunex, said that about 40,000 patients have used etanercept-alone or in combination with methotrexate-since its approval a year ago. A recent study showed that in addition to its use in patients with long-standing disease, the drug also acts as a disease-modifying antirheumatic drug (DMARD).

She cited a randomized, multicenter, double-blind study in 632 patients with early, active rheumatoid arthritis. Etanercept at 25 mg plus placebo tablets was compared with etanercerpt 10 mg plus placebo tablets to a third group getting methotrexate 7.5 to 20 mg plus placebo injections. Of those getting etanercept, 75% had their erosions halted or failed to progress. In addition, 25% showed actual regression of their joint erosions. Patients also maintained their progress over a year of treatment, with interim analysis indicating continuation into the second year.

No serious infections resulted with etanercept; the main noninfectious side effect was injection-site reactions in 37% of patients. Methotrexate resuited in nausea in 29%, rash in 23%, mouth ulcers in 14%, hair loss in 12%, myalgia in 8%, and epistaxis in 7%. And lung toxicity occurred in 1.5%. Finck said the company awaits Food & Drug Administration approval for etanercept as a DMARD.

In a separate report, etanercept appeared to be safe and effective in the extended treatment of polyarticular juvenile rheumatoid arthritis.

There are also two-year data on leflunomide. Three international controlled clinical trials, including a U.S. trial, in 1,339 patients involved a wide variety of populations with both early and late disease. …

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