Drugs offer fresh hope for arthritis

Biological drugs offer hope to rheumatoid arthritis sufferers, writes Rachel Liddle.

What is the story?
A new generation of drugs could offer hope to patients with rheumatoid arthritis (RA), according to media reports.

Three drugs that target the immune system have been shown to cut RA symptoms by up to 50 per cent and appear to halt progression of the disease.

MabThera (rituximab) and Orencia (abatacept) have been licensed for use in the UK. A third drug, tocilizumab, is undergoing late-stage clinical trials. The licensed drugs have yet to be approved for NHS use by NICE.

What is the research?
The findings come from a review of emerging biological therapies for RA published by the Lancet.

Each of the three drugs works in a unique way and could add to the armament of disease-modifying antirheumatic drugs (DMARDs), the researchers say.

Rituximab targets the CD20 antigen expressed on B cells. Because B cells have a role in disease pathogenesis, it is believed depleting them can help treat RA. Rituximab is approved for use in combination with methotrexate only.

Trials with rituximab have shown the treatment can reduce RA symptoms by 50 per cent in one out of three patients measured against the American College of Rheumatology (ACR) response criteria.

Abatacept works by interfering with the T-cell activation response. As with rituximab, it is licensed for prescription when other DMARDs, including tumour-necrosis factor (TNF) inhibitors, have failed.

Research has shown that among patients with RA taking methotrexate, who were also given 10mg/kg body weight intravenous abatacept, 40 per cent had a 50 per cent cut in RA symptoms on the ACR measure.

Tocilizumab is not yet licensed for use in RA, but is used to treat Castleman's disease in Japan, report the researchers. The drug targets interleukin 6, which is involved in RA pathogenesis.

Phase-II trial data indicates that, used in combination with methotrexate, an ACR response rate of 50 per cent was found in 40 per cent of patients.

Noted side-effects of the drugs include serious infections with rituximab and abatacept. Abatacept has also been linked with headache and dizziness.

Some patients who have taken tocilizumab have experienced headache, skin eruptions, stomatitis and fever, as well as increased cholesterol and liver enzymes.

What do the researchers say?
Lead researcher Professor Josef Smolen, from the Medical University of Vienna, said: 'With every new drug we have a number of patients we are able to treat.'

But patients with RA who are being treated successfully with established therapies should not be looking to switch to these newer therapies, he added. 'New does not necessarily mean better; new means new option.'

Professor Paul Emery, from the University of Leeds, also involved in the study, said: 'RA is treatable and some patients need complex therapies and need to be referred for specialist assessment.'

What do other experts say?
Professor David Scott, a rheumatologist in Norwich and medical advisor to the National Rheumatoid Arthritis Society, said the drugs could prove useful alternatives when anti-TNF drugs fail or prove unsuitable. This happens in around 30 per cent of patients.

'Anti-TNFs are not the answer to everybody's prayers, although for some people they are useful,' he said.

Professor Scott added that GPs 'should persuade their PCOs that patients with bad RA need these drugs'.

Informing patients

  • Three novel biological drugs could treat RA patients who have poor responses to existing therapies.
  • Rituximab and abatacept have been licensed for use in the UK.But NICE has yet to rule on their use in the NHS.
  • Tocilizumab has not yet been licensed and is undergoing stage-III clinical trials.
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