New Treatments for Rheumatoid Arthritis

The emergence of new drugs in the market gives RA sufferers more options, but there are also several challenges and risks linked to these drugs.

On May 20, 2006, The Wall Street Journal (WSJ) ran a story about the drug choices available to people with RA. Reporter David Hamilton reviews the growing number of drug options now available to treat RA and provide relief to sufferers. While the emergence of new drugs in the market gives RA sufferers more options, there are also several challenges and risks linked to these drugs. High costs, complicated administration of the the drugs and potenitally deadly side effects are issues patients must consider. To read the story, visit WSJ, “New Treatments for Rheumatoid Arthritis.” You will need a subscription to read the article.

HealthCentral's RA expert, Dr. Borigini and Christine Miller, HealthCentral's Patient Expert, offer their opinions on the new and existing RA drugs.

Dr. Borigini, Rheumatologist

Up until the last several months, the three main biologic agents used in the treatment of rheumatoid arthritis have been tumor necrosis factor inhibiting drugs, including Humira, Enbrel and Remicade. But now these agents have some competition from Rituxan and Orencia–two biologics which have been on the market for only the last few months. Today I will discuss Rituxan, a medication which targets B lymphocytes.

B lymphocytes are cells of the adaptive immune system which express cell surface receptors which can cause cells to react against themselves if not for our immune system’s ability to exhibit B cell tolerance. But if this tolerance fails, we produce antibodies against our own tissues, resulting in autoimmune disease, including rheumatoid arthritis.

Rheumatoid arthritis is associated with antibodies and if B cells could be removed, or at least disabled, the production of these auto-antibodies could be blocked, and perhaps the disease course altered.

Clinical trials with Rituxan–alone or in combination with either methotrexate or cytoxan showed a response after six months, similar to the response seen with the tumor necrosis factor inhibiting drugs. In fact, there was a persistent response seen after one year. Another study showed similar promising results. There have been no major safety concerns during the follow up of these study patients. In particular, we have not seen recurrent infections with Rituxan use; however, since it is fairly new on the market, both doctor and patient must watch for any ill effects as the use of the drug continues in the general rheumatoid arthritis population.

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