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Combination drug therapy could substantially improve symptoms of rheumatoid arthritis (pp 670, 675)
February 25, 2004The combination of two drugs - both partly effective for rheumatoid arthritis patients when given individually - could be an important development in substantially reducing symptoms and joint destruction for people with rheumatoid arthritis, conclude authors of a study in this week's issue of THE LANCET.
Rheumatoid arthritis affects around 1% of people worldwide. Etanercept and methotrexate are known to be effective in the treatment of rheumatoid arthritis; however, no data exist on concurrent initiation or use of the combination compared with either drug alone.
Lars Klareskog from the Karolinska Institute, Sweden, and colleagues studied 686 patients with current rheumatoid arthritis who were randomly allocated treatment with either etanercept (25 mg subcutaneously twice a week) or oral methotrexate (up to 20 mg every week), or combination of both treatments. Clinical response was assessed by criteria of the American College of Rheumatology (ACR) and by disease activity score (DAS).
ACR scores were better for symptom relief after 6 months for patients given combination treatment than for patients receiving individual drug therapy, and remission after one year (defined from DAS scores) occurred in 35% of patients given combination treatment compared with 16% of patients given etanercept monotherapy and 13% given methotrexate monotherapy. Combination therapy was also more effective for effects on joint destruction measured by radiography-resulting in a statistically significant improvement on a score for joint erosion.
Dr Klareskog comments: 'This is the first demonstration that erosions in established rheumatoid arthritis can improve over time in a group of patients within a controlled clinical trial, thus providing evidence that repair of joints destroyed by the disease may be a biological and clinical possibility'. (quote by e-mail; does not appear in published paper).
In an accompanying Commentary (p 670), Armin Schnabel from Sana Rheumazentrum Baden-W'berg, Germany, comments : 'Studies examining early versus delayed onset of immunosuppressive treatment and high versus low initial intensity of treatment suggest that effective treatment needs to be started during a critical time early in the course of the disease. During this window of opportunity, inflammation seems to be particularly susceptible to treatment and long-term preservation of structure and function probably relies heavily on the initiation of effective immunosuppression during this particular time span. Most trials involving antagonists of tumour necrosis factor, including ATTRACT, ARMADA, and TEMPO, comprised patients with disease of several years' duration. The next generation of trials will target patients with recent onset of disease and these trials are essential to support, or refute, the concept of the window of opportunity. If timing turns out to be the critical factor it seems to be, the benefits of disease-modifying antirheumatic drugs, biologicals, and the various combinations thereof will need to be reassessed.'
Lancet
ACR scores were better for symptom relief after 6 months for patients given combination treatment than for patients receiving individual drug therapy, and remission after one year (defined from DAS scores) occurred in 35% of patients given combination treatment compared with 16% of patients given etanercept monotherapy and 13% given methotrexate monotherapy. Combination therapy was also more effective for effects on joint destruction measured by radiography-resulting in a statistically significant improvement on a score for joint erosion.
Dr Klareskog comments: 'This is the first demonstration that erosions in established rheumatoid arthritis can improve over time in a group of patients within a controlled clinical trial, thus providing evidence that repair of joints destroyed by the disease may be a biological and clinical possibility'. (quote by e-mail; does not appear in published paper).
In an accompanying Commentary (p 670), Armin Schnabel from Sana Rheumazentrum Baden-W'berg, Germany, comments : 'Studies examining early versus delayed onset of immunosuppressive treatment and high versus low initial intensity of treatment suggest that effective treatment needs to be started during a critical time early in the course of the disease. During this window of opportunity, inflammation seems to be particularly susceptible to treatment and long-term preservation of structure and function probably relies heavily on the initiation of effective immunosuppression during this particular time span. Most trials involving antagonists of tumour necrosis factor, including ATTRACT, ARMADA, and TEMPO, comprised patients with disease of several years' duration. The next generation of trials will target patients with recent onset of disease and these trials are essential to support, or refute, the concept of the window of opportunity. If timing turns out to be the critical factor it seems to be, the benefits of disease-modifying antirheumatic drugs, biologicals, and the various combinations thereof will need to be reassessed.'
Lancet
Arthritis Current Events and Arthritis News RSSToo much physical activity may lead to arthritis
Middle-aged men and women who engage in high levels of physical activity may be unknowingly causing damage to their knees and increasing their risk for osteoarthritis, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).
Multiple health concerns surface as winter, vitamin D deficiences arrive
A string of recent discoveries about the multiple health benefits of vitamin D has renewed interest in this multi-purpose nutrient, increased awareness of the huge numbers of people who are deficient in it, spurred research and even led to an appreciation of it as "nature's antibiotic."
Can EP4 agonist alleviate gastric lesions?
Over 300 million patients use non-steroidal anti-inflammatory drugs (NSAIDs) in the world to treat pain, arthritis, fever and other diseases. Nearly 30% of the users suffer from gastric lesions and bleeding.
Thoughtful words help couples stay fighting fit
Couples who bring thoughtful words to a fight release lower amounts of stress-related proteins, suggesting that rational communication between partners can ease the impact of marital conflict on the immune system.
Penn Study Provides First Clear Idea of How Rare Bone Disease Progresses
An international team of scientists, led by researchers at the University of Pennsylvania School of Medicine, is taking the first step in developing a treatment for a rare genetic disorder called fibrodysplasia ossificans progressiva (FOP), in which the body's skeletal muscles and soft connective tissue turns to bone, immobilizing patients over a lifetime with a second skeleton.
Aileron collaborates study in Nature: Stapled peptides inhibit Notch1 transcription factor
This research validates the potential for Stapled Peptides to modulate key intracellular biological targets, such as transcription factors, that have not been addressable with current small molecule or biologic drug modalities.
Researchers find new way to attack inflammation in Graves' eye disease
A small group of patients with severe Graves' eye disease experienced rapid improvement of their symptoms - and improved vision - following treatment with the drug rituximab.
Common Pain Relievers May Dilute Power of Flu Shots
With flu vaccination season in full swing, research from the University of Rochester Medical Center cautions that use of many common pain killers - Advil, Tylenol, aspirin - at the time of injection may blunt the effect of the shot and have a negative effect on the immune system.
Mending meniscals in children, improving diagnosis and recovery
The meniscus is a rubber-like, crescent moon-shaped cartilage cushion that sits between the leg and thigh bone. Each knee has two menisci: one on the inside of the knee joint and one on the outside.
Study finds link between childhood physical abuse and arthritis
Adults who had experienced physical abuse as children have 56 per cent higher odds of osteoarthritis compared to those who have not been abused, according to a new study by University of Toronto researchers.
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