New Options For Rheumatoid Arthritis Treatment
By: Yvette J. Crockell, MHA, R.Ph
Two new medications, Enbrel and
Humira, represent recent breakthroughs in rheumatoid arthritis (RA) therapy and
offers new options to those who have not responded well to current treatment
options.
Rheumatoid
arthritis is a systemic disease that affects the entire body and is one of the
most common forms of arthritis. It is characterized by the inflammation of the
membrane lining the joint, which causes pain, stiffness, warmth, redness and
swelling. The inflamed joint lining, called the synovium, can invade and damage
bone and cartilage. Inflammatory cells release enzymes that may digest bone and
cartilage. The involved joint can lose its shape and alignment, resulting in
pain and loss of movement.
RA
can be chronic, which means it last a long time, and can be a disease with
flare-ups (active disease) and remissions (little to no activity). For these reasons, early
treatment is critical. Current treatment methods focus on relieving pain,
reducing inflammation, stopping or slowing joint damage, and improving patient
quality of life.
Up
to now, available medications to treat symptoms alone have included
Non-steroidal Anti-Inflammatory Drugs (NSAIDs), C0X-2 inhibitors, and
glucocorticoids. These drugs are often used alone or in combination with other
RA medications called Disease-Modifying Anti-Rheumatic Drugs (DMARDs) such as
methotrexate, sulfasalazine, and azathioprine. DMARDs can help slow or stop
joint damage, depending on how one responds to the prescribed medication.
However,
for people with moderate to severe RA who have not responded well to DMARDs and
other treatments now have new options available, Enbrel and Humira. These two groundbreaking medications
resemble a naturally produced protein in the body that work with your immune system
to help control the inflammation caused by RA. By enhancing the action of the
naturally occurring protein, these medications can help control the pain,
stiffness and discomforts of RA while inhibiting the progression of damage to
the joints.
Enbrel,
developed by Immunex, was approved in 1998 for reducing signs and symptoms and
inhibiting the progression of structural damage in patients with moderately to
severely active RA. In addition to RA,
Enbrel can also be used as a treatment for Juvenile RA and for patients with
psoriatic arthritis. It is a
self-injection given twice a week, 72 to 96 hours apart.
Humira, developed by Abbott Laboratories, was recently approved in
December 2002. Humira is indicated for
reducing signs and symptoms and inhibiting the progression of structural damage
in adult patients with moderately to severely active RA who have had an
inadequate response to one or more disease-modifying anti-rheumatic drugs
(DMARDs). Humira can be used alone or in combination with methotrexate or other
DMARDs. Humira is dosed less often, at
twice a month, and is also an injection.
Abbott laboratories has also announced that as of January 2003, they
will provide Humira free of charge to Medicare patients without other drug
coverage, until the government agrees to pay for the medicine.
In medical studies of Enbrel and Humira, patients reported significant
reductions in pain, fatigue, and improvements in ability to perform routine
tasks. For patients where Enbrel or
Humira may be an important new treatment option, it is important to discuss
this with your physician along with other treatment possibilities such as
lifestyle changes and exercise for managing your RA.