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Sorry if this is a duplicate. I saw it in the paper yesterday & thought it

was important:

newsday.com/news/health/sns-ap-fda-arthritis-drugs,0,1512342.story

Newsday.com

FDA warns that 4 drugs for rheumatoid arthritis raise risk of serious fungal

infections

By RICARDO ALONSO-ZALDIVAR

Associated Press Writer

5:28 PM EDT, September 4, 2008

WASHINGTON (AP) _ The Food and Drug Administration ordered stronger warnings

Thursday on four medications widely used to treat rheumatoid arthritis and

other serious illnesses, saying they can raise the risk of possibly fatal

fungal infections.

The drugs - Enbrel, Remicade, Humira and Cimzia - work by suppressing the

immune system to keep it from attacking the body. For patients with

rheumatoid arthritis, the treatment provides relief from swollen and painful

joints, but it's " a double-edged sword, " said the FDA's Dr. Siegel.

That's because the drugs also lower the body's defenses to various kinds of

infections.

Siegel, who heads the office that oversees arthritis drugs, said the FDA

became concerned after discovering that doctors seemed to be overlooking a

particular kind of fungal infection called histoplasmosis. Of 240 cases

reported to the FDA in which patients taking one of the four drugs developed

this infection, a total of 45 died - about 20 percent.

The infection, which mimics the flu, is prevalent in much of the middle part

of the country. It can have particularly grave consequences if it isn't

caught early and spreads beyond the respiratory system to other organs of

the body.

Siegel said the investigation began with a single case of a woman taking one

of the drugs who died of histoplasmosis. Delving into the case, doctors at

the FDA found that the woman had been sick with the fungal infection for a

long time. " This case led us to be concerned that there may be other

situations in which physicians may not recognize histoplasmosis, " said

Siegel.

FDA officials searched the agency's database and found the 240 cases of

patients taking the medications who had also developed the fungal infection.

Of those, at least 21 appeared to involve a late diagnosis, and 12 of them -

more than half - ultimately died.

Siegel said the FDA's order Thursday means that the risk of histoplasmosis

will be flagged in a " black box, " the strongest warning information in a

drug's prescribing literature. The four medications already have black box

warnings about the risk of infections, but the language varies from drug to

drug.

Patients should call their doctors if they develop persistent fever, cough,

shortness of breath or fatigue, which can be signs of the fungal infection.

And the FDA is also urging doctors to consider aggressive use of antifungal

drugs in patients who develop such symptoms, even if the infection has not

been confirmed by a laboratory test. Siegel said such a decision should not

be taken lightly, since antifungal drugs can also have dangerous side

effects. Doctors should consider stopping treatment with the

immune-suppressing drugs if patients develop infections.

The four drugs belong to a class known as TNF-alpha blockers, and are

considered a mainstay for treating rheumatoid arthritis, a disabling disease

in which the immune system attacks the joints. They are also used to treat

Crohn's disease, juvenile arthritis, certain types of psoriasis, and other

immune system disorders. All are taken by injection.

Separately, the FDA is investigating a possible link between the four

medications and cancer in young patients. The agency said earlier this year

it has received 30 reports of cancers, mainly lymphomas, in patients who

began taking the medications when they were 18 or younger. That

investigation is expected to take the rest of the year.

Three of the drugs, Enbrel, Humira and Remicade, are considered

blockbusters, with sales of over $1 billion annually for each. Cimzia is

newer and less widely used.

Humira is sold by North Chicago, Ill.-based Abbott Laboratories Inc; Cimzia

by Belgium-based UCB; Enbrel by Thousand Oaks, Calif.-based Amgen Inc. and

Madison, N.J.-based Wyeth; and Remicade by Horsham, Pa.-based Centocor, a

unit of & , and Kenilworth, N.J.-based Schering-Plough Inc.

Abbott shares fell $1.36, or 2.4 percent, to close at $56.64 Thursday; Amgen

fell $2.22, or 3.5 percent, to $60.88; Wyeth fell $1.54, or 3.6 percent, to

$41.47; and & fell $1.06 to $70.45.

___

On the Net: http://tinyurl.com/6aw662

Copyright 2008 Associated Press.