Insight Host KJ > Dr Cohen, thanks for coming
Dr. Cohen > sure
Insight Host KJ > Can you Tell us a little about yourself and your involvement in the Kineret studie
Dr. Cohen > i have been in rheumatology practice for 21 years and been involved in clinical research. I have worked with kineret for the last 10 years and have also worked with the development of enbrel, and arava as well as other new agents now under investigation
Insight Host KJ > What is Kineret? And how does it work?
Dr. Cohen > kineret is interleukin 1 receptor antagonist which is produced byyand is identical to the natural protein. It inhibits the ability of interleukin 1 a protein like TNF to activate cells that cause joint swelling and pain recombinant DNA technology
Insight Host KJ > is it treating the disease or just the symptoms?
Dr. Cohen > sorry for the typo, i meant to say kineret is a recombinant protein
Insight Host KJ > we're used to typos here!
Dr. Cohen > kineret helps the signs and symptoms of RA but based on one study looks like ti will retard joint destruction as well and a large study is ongoing to confirm that observation
Insight Host KJ > That's good news! How is it given and what are the side effects?
Dr. Cohen > it is give as a subcutaneous injection once daily. Side effects have been primarily mild to moderate injection site reactions and a slight increase in infections similiar to the TNF inhibitors
Insight Host KJ > OK....let's open the floor for questions...Please type a "?" if you have a question and DO NOT ask it until I call on you.
Insight Host KJ > In general, what has the patient response been?
Dr. Cohen > the patient response has been good. patient's generally have a intial response by 4 weeks and around 40%% of patients have what rheumatologists consider an important response
Insight Host KJ > Thanks Dr Cohen...go ahead swimmer
swimmer> At what point in the disease or medication history should a patient consider taking kineret?
Dr. Cohen > if active disease is still present after receiving one DMARD like arava or methotrexate or if not responsive or side effects to enbrel or remikade
Insight Host KJ > GUest 126 go ahead
Guest126> Are the injection site reactions treatable?
Dr. Cohen > the injection site reactions all occurred in the first 4 weeks and almost all resolve with continuing treatment. rarely we prescribe topical benadryl or cortisone
Insight Host KJ > After four weeks they disapear?
Dr. Cohen > they generally disappear. what i meant by 4 weeks is that if one doesn't have a reaction iin the first four weeks they won't have one
Insight Host KJ > AH, ok....OK giggles, your turn
Giggles> Can Kineret be taken by anyone with SLE as well as RA?
Dr. Cohen > there are no studies of kineret in patients with Lupus. However we are not concerned about possibly aggravating lupus with this therapy as we are with enbrel or remikade
Giggles> thanks
Insight Host KJ > Hannah...go ahead
Hannah> How does Kineret differ from enbrel?
Dr. Cohen > kineret blocks interleukin 1 whereas enbrel blocks tumor necrosis factor. Both cytokines are important in the joint inflammation and blocking either of thease is effective in improving the disease
Insight Host KJ > Annie....your turn
Annie> i heard that the injection was in a pen similar to those used by diabetics-if this is true are the needles smaller, and is it more convenient to travel with than enbrel?also-in the future might we look at taking both therapys
Insight Host KJ > Annie...you can view a video of the injection device at www.kineretrx.com
Annie> thanx
Dr. Cohen > the injection kit was designed with the help of RA patients and is user friendly . the patient can't actually see the needle when injecting. It is possible we will use both therapies in the future but more studies are ongoing to determine the safety and efficacy of the combination
Insight Host KJ > (Tery or Nicole....as patients on Kineret you can throw in yoru two cents whenever you want)
Insight Host KJ > 126 go ahead
Guest126> Is kineret made from all human components. I worry about having an allergic reaction like I did with Enbrel and Remicade.
Dr. Cohen > kineret is totally a human protein
Insight Host KJ > Dancey go ahead
Dancey> I am presently on Enbrel and doing well. Should I consider switching or possibly in the future taking both. Is Kineret in need of refrig?
Dr. Cohen > if you are doing well do not switch. yes refrigeration is necessary
Insight Host KJ > Tery go ahead
Tery> What is the longest that you've had someone on Kineret, have you had anyone go into remission on it, also did they take only Kineret or was another DMARD used with it?
Dr. Cohen > the longest is 5 years. all of thestudies conducted in the U.S. have been combination studies with methotrexate or other DMARDS. the patients continuing on therpy are doing very well
Insight Host KJ > guest 55 go ahead
Guest55> Have any studies been done on people with rhuematoid lung using Kineret? (IPF)
Dr. Cohen > no direct studies have been done. when a new theapy is approved the studies generally look at improvement in symptoms, radiograps and quality of life
Insight Host KJ > Dancey...go ahead
Dancey> Enbrel is very expensive. Is there a difference in the cost of Kineret?
Dr. Cohen > i am told it is about $1000 less per year
Insight Host KJ > Besides infections, were there any serious side effects reported from the studies?
Dr. Cohen > none other
Insight Host KJ > wow...ok 126 go ahead
Guest126> Have there been any allergic reactions?
Dr. Cohen > i am not aware of any allergic reactions
Insight Host KJ > Nicole...go ahead
NicoleG> i think it just got answered :)
Insight Host KJ > ok then Hannah go ahead
Guest10> How does Kineret compare to Imbrel, as to the relief of ra symptoms?
Dr. Cohen > ibelieve the response to kineret is similiar to enbrel although in the clinical trials there were somewhat more patients responsive to enbrel, but when a patient responds the response is similiar to the tnf inhibtors
Hannah> What type of infections did it cause and if a patient is not responding well to remicade (and experiencing severe side effects )would you recommend this?
Dr. Cohen > the infections wer predominantly upper respiratory infections. the serious infections were pneumonia and skin infections such as cellulitis. if nonresponsive or toxic to remikade this would be a reasonable option
Insight Host KJ > HIgher or lower infection rate than the TNFs?
Tery> I've had 2 URI in the 11 months I've been on it
Dr. Cohen > very similiar rate certainly no worse
Insight Host KJ > guest 50 go ahead
Guest50> I have been on them all I am now on Remicade and arava, remicade is no longer working, is this an option, I can no longer take meth, what can I expect
Dr. Cohen > i think kineret isan option if remikade is no longer working and can be given with arava
Insight Host KJ > has it been studied with arava? my doctor wasnt aware that it was
Dr. Cohen > yes in the large safety trial 10%% of the patients were on arava and no safety issues arose
Insight Host KJ > cool! Dancey go ahead
Dancey> So URI could happen with either Enbrel or Kineret?
Dr. Cohen > even without these drugs the studies have demonstrated that RA patients have more frequent URIs
Insight Host KJ > Nicole...your turn
NicoleG> what causes the injection site reactions?
Dr. Cohen > we don't exactly know
Insight Host KJ > guest 55 go ahead
Guest55> Has Kineret been studied with prednisone?
Dr. Cohen > yes in all the studies more than 50%%of the patients were on concomitant prednisone
Insight Host KJ > Giggles...go ahead
Giggles> what is URI?
Dr. Cohen > upper respiratory infections such as colds, sinus infections
Insight Host KJ > Hannah...go ahead
Hannah> My ? relates to pred as well. If patients were on pred were they able to wean off of it due to success of kineret?
Dr. Cohen > that has not been lookedat in the clinical trials but may be looked at in ongoing studies
Insight Host KJ > Tery...go ahead
Tery> In the studies you were involved in did the people on placebo also have injection site reactions?
Dr. Cohen > yes but not as frquently as the kineret treated patients
Insight Host KJ > Dancey...go ahead
Tery> Also, just wanted to add that in my study which is for 3 years during the first year you could not change your prednisone dosage
Insight Host KJ > Thanks Tery
Dancey> If you have an infection and are on antibiotics, do you have to go off the Kineret?
Dr. Cohen > we suggest holding the kineret in the presence of an infection similiar to what most docsdo with enbrel or remikade. one advantage to kineret is that it is out of the system within 36-48 hours
Insight Host KJ > Marj...go ahead
marjidoll> Is it approved for children with JRA?
Dr. Cohen > not at this time but a study is in the process of being initiated
Insight Host KJ > Giggles....go
Giggles> you said before that it has been shown to maybe retard joint distruction, what about slowing down joints once they have started?
Dr. Cohen > yes in a joint that is already damaged we believe kineret as well as other DMARDS may slow the damage
Insight Host KJ > 126 you can have our final question
Guest126> What percentage of patients discontinue kineret due to the injection site rxns.
Dr. Cohen > in the studies 5-6 %%
Insight Host KJ > Dr. Cohen....is there anyting you wanted to cover and didnt get the chance?
Dr. Cohen > no i think thru the quetions we cover the information
Insight Host KJ > GReat, we really appreciate you taking the time to talk with us.
Dr. Cohen > thank you
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