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DMARDs
In Depth
DMARDs-In depth
We'll continue our
discussion with two of the newer DMARDs, Arava and Enbrel.
Enbrel
Approved in 1998, Enbrel quickly become the drug of choice for those that had failed previously available DMARDs. Given twice weekly by injection, it requires in office training before you can give it yourself at home. Although it appears to work very well for about 65% of the people who've tried it, its cost, around $1000 per month, makes it nearly impossible for those without pharmacy insurance to obtain. Enbrel may be taken alone or in combination with other DMARDs, most commonly Methotrexate. Unlike methotrexate and other DMARDs Enbrel seems to work quickly with many people noticing an improvement in symptoms after just a few injections.
Enbrel is considered a biologic response modifier, it works by decreasing the amount of a certain protein related to inflammation, the Tumor Necrosis Factor. Everyone needs TNF, but it is
though that those with inflammatory arthritis have too much TNF. Enbrel captures the excess TNF before it can go to work causing inflammation.
The most common side effect of Enbrel is an injection site reaction. The area may become red, swollen and itchy. The most serious reported side effect of Enbrel is the risk of serious infection. Enbrel should not be used in the presence of an infection. If you develop an infection while on Enbrel call your doctor right away. Another rare, but notable adverse reaction is the formation of certain anti-bodies, including the antinuclear antibody. Other side effects include headache, runny nose and nausea.
Enbrel is relatively new to the scene so long term effects are not yet known. It has not been studied in pregnancy or nursing mothers and should not be used unless absolutely necessary.
Enbrel requires no routine lab work, which might make up for those twice weekly injections!
Arava
Just a couple of months before Enbrel was approved, the FDA granted approval for another new DMARD, Arava. Arava is taken by mouth, usually 100mgs a day for three days as a loading dose, then 20mg per day thereafter. Most people begin to notice an improvement in as little as a month.
Arava works by inhibiting certain enzymes, dihydroorotate dehydrogenase, and has an anti inflammatory response as well. Studies have shown Arava to be slightly more effective at slowing the disease process than MTX.
Like MTX, Arava's side effects can include liver problems, GI disturbances, and hair loss. Blood tests to monitor liver function should be done at least monthly in the beginning and then at the
discretion of your doctor. Because of the risk of liver damage, Arava should not be taken by those with pre existing liver problems.
Arava should never be taken during pregnancy and should be avoided by both partners prior to conception. Arava has a very long half-life and stays in the body longer than other DMARDs.
Cholestyramine may be used to speed the elimination of the drug in those considering becoming pregnant or suffering harmful side effects.
Like the other newer DMARDs, the long term effects of Arava are still unknown. Only time will tell.
Sources:
Arava.com
Enbrel.com
Mosby's GenRx?, 10th ed.
Copyright ? 2000 Mosby, Inc.
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