The Efficacy And Tolerability Of Newer Biologics | Arthritis Information

 

Rheumatoid arthritis (RA) is a chronic, inflammatory, incurable disorder of uncertain etiology, associated with significant morbidity. Patients require potentially lifelong treatment and there may be a substantial socioeconomic impact. RA is the most common inflammatory polyarthropathy, affecting ≈1% of the world's adult population;^[1] over two million people are affected by the disease in the US alone.^[2] Generally, the onset of RA is seen in middle age (40-70 years), with a 2.5-fold higher prevalence in women than in men.^[1]

Early diagnosis and treatment is an integral part of the management of RA, with the aims of reducing and controlling symptoms of joint pain and inflammation, minimizing loss of function, and reducing joint damage and disability.^[3]

Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, have long been the mainstay of treatment and are still advocated as a first-line option in newly diagnosed patients with RA.^[3,4] The advent, during the late 1990s, of biologics specifically targeting cytokine mediators in the inflammatory cascade has revolutionized the management of RA. The tumor necrosis factor (TNF)-α-antagonists infliximab, etanercept, adalimumab, and the interleukin (IL)-1 receptor antagonist anakinra, were the 'first generation' of biologics to be approved in the treatment of RA. These agents had a quicker onset of action than traditional DMARDs, produced rapid and sustained therapeutic responses, and did not require regular laboratory monitoring. However, approximately 30-40% of patients with established disease fail to respond to TNF-α antagonists and the majority of those that respond initially, do not achieve complete remission.^[5] Concerns have also been raised about the short- and long-term tolerability of these agents.^[3,6,7] This has prompted investigations into new targets and development of biologics with alternative mechanisms of action for the treatment of RA. Several new agents have been examined in clinical trials during the last few years.

http://www.medscape.com/viewarticle/556076 This article is a long read but has very good information and great comparative study of the differing newer biologics.  Anyone looking to further their knowledge so they may easier talk to their doctors should read this!

And Lev, check this out;
Combining rituximab 500mg or 1000mg with methotrexate, or rituximab 1000mg with cyclophosphamide, was effective in long-standing RA that was previously refractory to methotrexate monotherapy;^[8-10] rituximab monotherapy appeared to have moderate efficacy that was not sustained beyond 6 months in a relatively small-sized trial.^[8] Data available in only abstract form show that rituximab in combination with methotrexate may be highly effective in long-standing, active RA with inadequate response to anti-TNF-α therapy.<sup>[14,15]

And;</sup>  In combination with methotrexate, abatacept 10 mg/kg slowed the radiographic progression of disease in long-standing RA in patients who had not responded adequately to previous methotrexate monotherapy.^[13] Rituximab 1000mg with methotrexate also appeared to be effective in slowing the radiographic progression of long-standing, active RA with inadequate response to anti-TNF-α therapy, according to the results of a well designed trial available as an abstract.<sup>[20] 

This is so encouraging;</sup>  The incidence of serious infections with the biologics was low and no confirmed case of tuberculosis was reported in any of the trials; unconfirmed tuberculosis was reported in one patient each in abatacept and control groups in one trial.^[13] Human chimeric antibodies to the biologics were observed in up to ~4% of patients receiving rituximab^[8,9] and in ~1% of abatacept recipients.^[13,16] However, these did not appear to be associated with toxicity or a decrease in efficacy.<sup>[8,9,13,16]


Lynn, you are a jewel!  Thank-you for a great article!</sup>

Thanks Lynn this is more up my allie than mortality. LOL Some days I can talk about that subject but today isn't one of them. This is an encouraging post.

Bump for the newbies. 

THANKS LYNN FOR ALL THE GOOD INFO YOU POST ON THIS FORUM UNLIKE THE COMMENTS BY AA OR WHOEVER IT IS. I FOR ONE AM SO TIRED OF COMING IN HERE TO READ GARBAGE POSTINGS AND ALL THE FUSSING GOING ON. I PROBALLY DON'T KNOW THE WHOL;E STORY WITH IT AND REALLY DON'T WANT TO BUT I COME IN HERE TO READ INFO AND GET SUPPORT AND BE OF SUPPORT BUT AM VERY TIRED OF ALL THE ATTACKING COMMENTS THAT HAVE BEEN MADE LATELY. MAYBE IF SOME OF US WHO ARE USUALLY QUIET ABOUT EVERYTHING SPEAKS UP MAYBE THEY WILL STOP ALL THE BULLYING AND NASTINESS. LYNN I REALLY FEEL LIKE YOU PROVIDE GOOD ARTICLES PERTAINING TO THIS DESEASE AND I HOPE YOU WILL CONTINUE. I JUST POSTED A COMMENT TO THE POSTING THAT BIOLOGICS WILL KILL YOU THAT IS SO LUDICRIS TO EVEN POST IN HERE WHEN THERE ARE PEOPLE WHO DEPEND AND HAVE TO HAVE THESE DRUGS TO HAVE A DAILY LIFE WORTH LIVING. I GUESS WE CAN SEE THE ONES IN THE DRS OFFICES THAT HAVE HAD RA FOR A LONG TIME AND BACK WHEN THERE WAS NO MEDS TO CONTROL THE DAMAGE THAT LOOK LIKE HOW DO THEY EVEN GET AROUND AND FOR THAT COMMENT TO BE MADE JUST MAKES ME CRAZY. SORRY FOR RANTING ON THIS POSTING BUT MY GOODNESS MY PATIENTS IS WEARING THIN. I LOVE COMING IN HERE TO MEET PEOPLE AND READ ABOUT OTHERS AND HOW THEY DEAL WITH STUFF. PLEASE LETS JUST HAVE A FORUM TO HELP ONE ANOTHER. THANKS AGAIN LYNN I REALLY APPRECIATE YOUR TIME AND EFFORT TO PUT OUT GOOD INFO. lAURAYou're all welcome
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