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New Arthritis Therapies

Posted Aug 24 2008 1:49pm
ANNOUNCER: Rheumatoid arthritis causes the immune system to malfunction and attack the joints and organs of the body. Increasingly, doctors are adding newer agents such as TNF inhibitors and other biologic therapies to fight the disease.

CLIFTON O. BINGHAM, MD: The reason that we know that TNF is so important is because of the effect of blocking this cytokine with drugs. And when we inhibit TNF, we see a reduction in all of the signs and symptoms of rheumatoid arthritis. We see a reduction in these things called acute phase reactants, sed rate and CRP, reflecting a reduction in systemic inflammation. And we also see inhibition of the joint damage that takes place when TNF is present.

ANNOUNCER: Available TNF inhibitors include etanercept, adalimumab and infliximab. Potential side effects can range from the less serious, like reactions at the site of injection and infusion reactions, to infections, including reactivating latent tuberculosis. Other serious concerns include a potential increase in malignancies and lymphoma.

ERIC RUDERMAN, MD: One of the issues that comes up with biologic agents is that because they're proteins, they can't be given as tablets; they can't be given orally, because they become digested. They don't get absorbed properly, so they have to be given either as an injection or as an intravenous infusion. But once we get them into the body, we can use them to target specific signals and block those signals from progressing.

ANNOUNCER: For patients who have not found relief with TNF inhibitors, there are newer biologic agents, including co-stimulation modulators. These agents target specific interactions between cells.

ERIC RUDERMAN, MD: We can use biologic agents to try to target different places in that interaction, and by doing so reduce the disease process itself.

CLIFTON O. BINGHAM, MD: Recently, a medication called abatacept or Orencia was approved for the treatment of patients with rheumatoid arthritis. And it acts very specifically to inhibit the T-cell and its early activation. This medicine is also given by intravenous infusion.

Another biological DMARD that we have is called rituximab or Rituxan. It targets the B-lymphocyte or B-cell, which we now understand is an important player in rheumatoid arthritis. This is a medicine that's administered by intravenous infusion, two infusions given two weeks apart, yet the results of this medication can be improvements that last for many months after the initial infusion. The final approved biological DMARD that we have is a medicine called anakinra or Kineret, which inhibits the activity of interleukin-1, another pro-inflammatory cytokine in RA.

ANNOUNCER: Side effects can range from the less severe, like reactions at the site of injection, infusion reactions, headaches, nausea and upper respiratory infections, to the more serious, like pneumonia and heart problems.

CLIFTON O. BINGHAM, MD: These are more powerful bullets, if you will, in the treatment of patients with RA. And one of the things that we see with all of these medications is an increased risk of infection. There are slight differences in terms of some of the infections that might be seen with one drug versus another, but overall it's important to recognize that increased risk of infection is something that's common across many of these biological DMARDs.

ANNOUNCER: These new agents are changing the way people view rheumatoid arthritis.

ERIC RUDERMAN, MD: If you look at the studies that are out there with the different drugs, the number of people who go into remission is in the range of 40 to 50 percent, which is really a level of response that we didn't think we'd achieve even just ten years ago. And so our goal is resolution of disease. The disease should be completely under control and not interfering with life in any way, with the hope being that then people can do better now, and if the disease is completely under control, they're not going to have the damage that's going to go on that's going to lead them to problems later. And that's a realistic goal.

ANNOUNCER: Researchers are looking at future biologics that target different cytokines in the immune system.

ERIC RUDERMAN, MD: There's a drug that blocks interleukin-6, another signaling protein, that's in late stages of testing that is very likely to become available in the next year or two, barring some unforeseen problems.

CLIFTON O. BINGHAM, MD: I think the future for treatment with rheumatoid arthritis is extremely exciting. We have a pipeline of agents that are coming down that are going to be useful, I think, in helping us to manage patients with RA. And it is my hope and my dream that, in fact, we can ultimately find a cure of the disease.

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