The question invariably asked by every rheumatoid arthritis patient: Do I have to take these medications for the rest of my life?
I do not know the answer to this question for any individual patient. But I do know that the answer, in general, is usually, yes.
Yes, because there is no cure for rheumatoid arthritis. Yes, because most patients suffer a flare of their rheumatoid arthritis when they stop their medications.
We all need better means of putting this disease into remission.
A recent study presented at the American College of Rheumatology meeting in San Francisco a couple of months ago found that prescribing biologic agents (such as Enbrel, Humira or Remicade) early in the course of rheumatoid arthritis may have the effect of quieting the disease for many years.
In this particular study, the drug used was Enbrel, added to methotrexate in patients who were fairly new to the aches and pains of rheumatoid arthritis. Interestingly, this action doubled the remission rate a year later, even if the Enbrel had been discontinued.
While the initial study was only 48 weeks, continued observation of the study subjects found sustained remission up to three years AFTER the discontinuation of Enbrel.
The researchers concluded that there is an opportunity, when rheumatoid arthritis has just been diagnosed and is less intense; to treat aggressively, with the likely result that there will be a better chance of remission.
Of course, we do not know whether other drugs used early and aggressively might achieve the same results. It appears that it is key to conquer the inflammation quickly, and the biologic agents are fairly effective in terms of achieving a rapid response. Hopefully, patients could stop these biologic agents and remain in remission. The long-terms use of the biologic drugs is still concerning, simply because they have not been around for all that many years; their early use and subsequent discontinuation could alleviate the concerns.
The study presented in San Francisco found that after the first 24 weeks, 85% of Enbrel-treated patients achieved remission, compared to 35% in the patients treated only with methotrexate. After 48 weeks, twice as many patients treated with Enbrel were in remission compared with those patients only taking methotrexate, no matter whether Enbrel had been withdrawn or not. In fact, patients who stopped Enbrel after 24 weeks had the highest remission rate when examined at 48 weeks.
And so, perhaps some rheumatoid arthritis patients will be able to stop at least one drug, provided it is started early enough.
Remission will remain out of the reach of many patients, even if patients are routinely started on, say, Enbrel early in the course of their illness. We are all left to wait for more treatment breakthroughs.