The Future of Arthritis Drugs

The Future

If the next two years are as productive as the last two years, the future for those of us with RA is looking pretty bright. There are many studies currently underway, some looking at the genetic factors, others to develop new and better drugs, still others are looking into non-drug treatments.

Enbrel and Remicade are the first drugs in a new class called biologic response modifiers. These drugs have been developed to target and act against specific components of the immune system. Both Enbrel and Remicade target the TNF (tumor necrosis factor). New drugs targeting that same factor are in development now as are other biologic response modifiers that target other immune system components. Interleukin-12 (IL-12) is one of those components. It is a cytokine that is involved in autoimmune diseases, they are working on developing a DMARD that can decrease IL-12 production, thus slowing the disease process. Others are working to target the interleukin (IL)-1alpha and IL- 1beta. The T cells are also involved in the inflammatory processes. A vaccine that targets these cells is being studied.Other drugs currently being studied include new NSAIDs with less GI side effects than even Celebrex or Vioxx.

Other drug studies are researching new combinations of currently available medications to achieve better results.

An interesting non-drug therapy currently being investigated at the University of Wisconsin involves raising the body temperature to 48.1 C (107 F) for one hour. This is thought to induce TNF receptors and interrupt the inflammatory immune response.

A huge study taking place now is the North American Rheumatoid Arthritis Consortium. This group of 12 research centers around the United States is collecting medical information and genetic material from 1,000 families in which two or more siblings have rheumatoid arthritis. It will serve as a national resource for genetic studies of this disease.

Scientists are studying the confusing connection among the hormonal, nervous, and immune systems in rheumatoid arthritis. They are exploring whether and how the normal changes in the levels of steroid hormones (such as estrogen and testosterone) relate to improvement, or flares of the disease. Since RA strikes women three times as often as men, they are looking into female and male hormones and other elements that differ between women and men.

They are examining why rheumatoid arthritis often improves during pregnancy. The theory is that there are differences in certain special proteins between a mother and her unborn child. These proteins help the immune system distinguish between the body?s own cells and foreign cells. Such differences, the scientists speculate, may change the activity of the mother?s immune system during pregnancy.

With all this research and more going on, could a cure be within our grasp? ?Cure in our lifetime? I like the word, control, rather than cure. Take Enbrel when it works – it’s not a cure but it clearly controls the disease.? Says Dr. Susan Hoch. ?Cure implies it is gone forever. I think control is a more realistic goal.?

Raising my pill bottle in a toast?here?s to a future filled with control for all of us.

References:The role of IL-12 in inflammatory activity of patients with rheumatoid arthritis, Kim, W-U, et al, Clinical and Experimental Immunology 2000;119:175-181.
Targeting the T cell receptor in rheumatoid arthritis.
Kotzin BL, Kappler J., Arthritis & Rheumatism 1998;41:1906-1910.
NIAMS Handout on Health: RA