Drug May Help Alleviate Spinal Arthritis

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Drug May Help Alleviate Spinal Arthritis

Wed May 1, 6:11 PM ET

By Stenson

NEW YORK (Reuters Health) - The rheumatoid

arthritis drug etanercept (Enbrel) can

help ease symptoms of another type of

arthritis known as ankylosing spondylitis,

which primarily affects the spine, new

study findings suggest.

" This is the first class of drugs to show

an effect on spinal symptoms, " study

author Dr. C , Jr., told Reuters

Health. " The hope is that if you can

decrease the inflammation of the spine,

you can decrease the progression of the

disease. "

Ankylosing spondylitis can eventually

cause affected vertebrae to fuse together,

resulting in severe back pain and

disability. In addition to inflammation of

the spine, the disease may lead to pain in

the hips, knees and other major joints. It

usually develops between ages 20 and 40,

and affects more men than women. About 129

out of 100,000 people in the US have the

condition, and it is most common in Native

Americans, according to the American

College of Rheumatology.

Medications such as nonsteroidal anti-

inflammatory drugs, corticosteroids,

sulfasalazine and methotrexate are used to

treat the disease but only help symptoms

in peripheral joints, not in the spine,

said. Etanercept belongs to a class

of drugs known as tumor necrosis factor

(TNF) blockers. Research has already

suggested that another drug in this class,

infliximab (Remicade), may help treat the

condition, he noted.

" TNF has been shown to be critical in

inflammation, " said, and there is

evidence that TNF, a protein, occurs in

high levels in the joints of patients with

ankylosing spondylitis.

and colleagues at the University of

California, San Francisco, studied 40

patients with active ankylosing

spondylitis, half of whom were given

twice-weekly injections of etanercept

while the others were given an inactive

placebo. Study participants were allowed

to continue taking any medications they

had already been using to treat the

condition.

Of the 37 patients who completed the 4-

month study, 80% of those in the

etanercept group showed marked improvement

in at least three of five measures:

morning stiffness, spinal pain, joint

swelling, functioning and patient

assessment of disease activity. By

comparison, 30% of patients in the placebo

group showed such improvement, according

to results published in the May 2nd issue

of The New England Journal of Medicine

(news - web sites).

Those in the etanercept group also

reported a better quality of life,

particularly with regard to physical

functioning and bodily pain, results

showed. Side effects were not serious and

did not differ substantially by group,

according to the report. The most common

complaints involved reactions at the

injection site and minor infections.

After the study was completed, all

participants were offered the opportunity

to take etanercept for an additional 6

months. Those who had previously been

given placebo subsequently responded as

well to etanercept as those who had

received the drug during the first phase

of the study, and colleagues report.

While etanercept led to an " impressive

improvement " in the new study, more

research is needed to understand the

underlying causes of the disease and to

determine just how safe and effective the

drug is against the disorder, according to

an accompanying editorial written by Dr.

Jean-Michel Dayer of Geneva University in

Switzerland and Dr. M. Krane of

Massachusetts General Hospital- East in

town.

The study was partially funded by Immunex,

the maker of Enbrel. has consulted

for the company.

SOURCE: The New England Journal of

Medicine 2002;346:1349-1356, 1399-