New drugs for RA reviewed in NEJM

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Rheumawire

May 21, 2004

New drugs for RA reviewed in NEJM

Nashville, TN - New drugs for the treatment of rheumatoid arthritis are

reviewed in some detail in a " Drug Therapy " article in the May 20, 2004

issue of the New England Journal of Medicine [1].

Authors Drs Olsen and Stein (Vanderbilt University School

of Medicine, Nashville, TN) discuss in turn:

Leflunomide (Arava®, Aventis).

Etanercept (Enbrel®, Amgen/Wyeth).

Infliximab (Remicade®, Centocor/Schering-Plough).

Adalimumab (HumiraTM, Abbott).

Anakinra (Kineret®, Amgen).

All of these drugs appear to be more effective than placebo and to slow

the progression of disease as measured radiologically and so are

classified as disease-modifying antirheumatic drugs (DMARDs), the review

article explains. It also makes the following comments:

Methotrexate (MTX) remains the most commonly used DMARD, but

leflunomide is a useful alternative in the face of intolerance to MTX.

The TNF antagonists appear to be the most effective treatments

available for RA, and response is generally rapid, but not all patients

have a response. Three of these agents are now commercially available,

but there is little information regarding head-to-head comparisons. Much

of the information on safety and adverse effects remains unpublished,

although it can be found in the transcript of a meeting of the FDA

Arthritis Advisory Committee [2]. (Details from this meeting were

reported at the time by rheumawire). It's unclear whether some of these

adverse effects are particular to 1 product or pertain to the class as a

whole, and so, until convincing data to the contrary are available,

similar precautions should apply to all the TNF antagonists.

The interleukin-1 blocker anakinra may be useful in patients who

have no response to or who are unable to tolerate methotrexate,

leflunomide, or the TNF antagonists.

Much remains unknown, however. Hard data regarding the comparative

long-term efficacy and toxicity of these agents, as well as the variable

rates of response, will be important for rational clinical use, Olsen

and Stein conclude.

Zosia Chustecka

Sources

1. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med

2004 May 20; 350(21):2167-79.

2. FDA Center for Drug Evaluation and Research, Arthritis Advisory

Committee. Safety update meeting on TNF-blocking agents. Food and Drug

Administration March 4, 2003. Available at:

http://www.fda.gov/ohrms/dockets/ac/03/transcripts/3930T1.htm.

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Mayo Clinic in Rochester

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s Hopkins Medicine

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