New Treatments for Inflammatory Arthritis: Biologics

[Guest guest]

Biologics for Rheumatoid Arthritis Treatment

New Treatments for Inflammatory Arthritis: Biologics

http://www.webmd.com/solutions/treatments-rheumatoid-arthritis/promising-advance\

s?rp=refp_rctr_abbo_humh

There have been some promising advances in the past few years in treating

rheumatoid arthritis and other forms of inflammatory arthritis such as

ankylosing spondylitis and psoriatic arthritis -- especially for those

people who do not respond to disease-modifying drugs. The most important

advance has been the development of a group of drugs called biologic

response modifiers or biologics.

There are several biologics approved to treat arthritis. They include:

a.. Enbrel

b.. Humira

c.. Kineret

d.. Remicade

e.. Rituxan

f.. Orencia

There are also other biologics being studied to treat various forms of

arthritis.

How Do These Drugs Work?

Biologics are drugs derived from living organisms and are designed to either

inhibit or supplement a specific component of the immune system called

cytokines. These cytokines play a pivotal role in either fueling or

suppressing inflammation (a key component in several forms of arthritis such

as rheumatoid arthritis and psoriatic arthritis).

Enbrel, Humira, and Remicade inhibit a cytokine called tumor necrosis factor

or TNF. Kineret blocks the cytokine interleukin-1 (or IL-1). Rituxan

selectively targets immune cells known as CD20-positive B cells.

What makes these drugs so different from other drugs used to treat RA that

modify the immune system (see the DMARDs article) is that biologics affect a

specific component of the immune system, not the entire immune system. Thus,

these drugs theoretically have fewer side effects.

These drugs may take a few weeks to notice a significant effect.

What Are the Side Effects?

As with any drugs that suppress the immune system, biologic therapy might

pose some risks, since it could make your body more vulnerable to other

infections and diseases. Patients should seek immediate medical attention if

they develop persistent fever.

Biologics may also cause some chronic diseases in remission -- such as

tuberculosis -- to flare up, and they are often not recommended for people

with multiple sclerosis and other conditions.

Since biologic therapy is only in its early stages of use, some of the

long-term effects of using these medications simply aren't known, and your

doctor will probably want to regularly monitor your health while using them.

Biologics are also currently more expensive than conventional treatments.

However, the evidence so far is that they work well and pose fewer risks

than other systemic therapies.

One disadvantage to biologic medication is that it has to be given either by

injection or by intravenous infusion; the latter approach can take two hours

per session. However, the advantages of these drugs appear to be numerous.

Although animal studies have shown no effect on fertility or impairment of

the fetus, these studies cannot always predict the effects in humans.

Accordingly, pregnant women should receive these drugs only if clearly

needed.

Here are some details on each drug:

Enbrel

Enbrel reduces joint inflammation by blocking a cytokine called tumor

necrosis factor, or TNF.

Enbrel is given by self-injection under the skin once or twice a week. Many

people learn to give their own injections or receive them from a family

member who has received proper instruction. A kit is available from the

manufacturer that makes drawing up the medicine and injecting it easier.

Studies on Enbrel suggest that it may cause irritation at the injection

site.

Enbrel's effect can also weaken the immune system. Although rare, some

people have developed serious infections while taking Enbrel. Anyone with a

serious infection should stop taking Enbrel and resume it after being

advised by a doctor. If you develop an infection, let your doctor know

immediately as you need to be monitored closely.

Pregnant women should not take Enbrel because the effects on a developing

child are unknown.

Humira

Humira blocks the cytokine tumor necrosis factor. The drug is an injection

that can be self-administered. It is usually taken once every two weeks.

Rare cases of severe allergic reactions and blood cell deficiencies have

occurred with Humira. Bruising or bleeding can be a sign of blood cell

problems and should be reported to your doctor immediately.

In addition, serious infections have been seen in clinical trials when

Humira was taken with another rheumatoid arthritis drug Kineret.

Kineret

Kineret reduces joint inflammation by blocking the cytokine interleukin-1.

The drug is administered as one injection daily (can be self-injected or

given to you by another individual).

Tell your doctor if you develop signs of an infection, such as fever.

Remicade

Like Enbrel, Remicade reduces inflammation by blocking the cytokine tumor

necrosis factor. Remicade is given by intravenous infusion in the doctor's

office or hospital. Each infusion takes about two hours. The intravenous

treatments are given three times during the first six weeks of therapy, then

every eight weeks. Remicade is given with methotrexate for treating RA.

As with other biologics, treatments may weaken the body's ability to fight

infection. If you have any signs of infection such as a fever over 100F,

sweats or chills, skin rash, or other symptoms that cause concern, contact

your doctor right away. Researchers say that future agents, still in the

early development stages, may be less expensive and will be taken orally.

Also on the horizon are biologics that target different cytokines.

With any treatment, it is important to meet with your doctor regularly so he

or she can closely monitor you to detect the development of any side effects

and monitor your treatment if necessary. Your doctor may periodically order

blood tests or other tests to determine the effectiveness of your treatment

and the presence of any side effects.

Rituxan

In February 2006 the FDA approved RituxanFDA approved Rituxan for the

treatment of RA. It's intended for patients with moderate-to-severe RA who

have not improved with TNF antagonists, such as Enbrel or Remicade. Rituxan

is given as two infusions in the vein -- separated by two weeks -- in

combination with methotrexate.

The most common side effects seen in clinical trials were infections and

reactions soon after the medicine is given (called infusion reactions).

Symptoms of infusion reactions include flu-like illness, fever, chills,

nausea, and headache.

Severe infusion reactions, including death, have been seen in lymphoma

patients treated with Rituxan.

Orencia

Orencia was approved in December 2005 for the treatment of moderate to

severe rheumatoid arthritis. It is the first in a new class of drugs that

also focuses on the immune system. Orencia blocks signals that are needed to

activate T-cells of the immune system. Activated T-cells play an important

role in the development of rheumatoid arthritis.

Orencia is approved to reduce the symptoms of RA in patients not helped by

other RA drugs. It can be taken alone or with other medications except

anti-TNF drugs and Kineret.

Orencia is given by intravenous infusion. Adverse reactions include

infection and serious allergic reaction. Patients shouldn't receive live

vaccines while taking Orencia or within three months of stopping the drug.

Caution should be used in prescribing Orencia for patients with chronic

obstructive pulmonary disease (COPD). Those patients' respiratory health

should be monitored. Orencia should be used during pregnancy only if clearly

needed. Nursing mothers should talk to their doctors about the risks and

benefits of taking Orencia.

Reviewed by the doctors at The Cleveland Clinic Department of Rheumatic and

Immunologic Diseases.

[Guest guest]

Here is an article posted awhile ago that has some Kineret info in it. I'll keep

looking to see if I kept anything else.

New Treatments for Inflammatory Arthritis: Biologics

New Treatments for Inflammatory Arthritis: Biologics

http://my.webmd.com/content/article/78/95638.htm?printing=true

There have been some promising advances in the past few years in

treating rheumatoid arthritis and other forms of inflammatory arthritis

such as psoriasis -- especially for those people who do not respond to

disease-modifying drugs. The most important advance has been the

development of a group of drugs called biologic response modifiers or

biologics.

There are several biologics approved to treat arthritis. They include:

* Enbrel (approved to treat RA and psoriatic arthritis)

* Humira (approved to treat RA)

* Kineret (approved to treat RA)

* Remicade (approved to treat RA)

There are also other biologics being studied to treat various forms of

arthritis.

How Do These Drugs Work?

Biologics are drugs derived from living organisms and are designed to

either inhibit or supplement a specific component of the immune system

called cytokines. These cytokines play a pivotal role in either fueling

or suppressing inflammation (a key component in several forms of

arthritis such as rheumatoid arthritis and psoriatic arthritis).

Enbrel, Humira, and Remicade inhibit a cytokine called tumor necrosis

factor or TNF. Kineret blocks the cytokine interleukin-1 (or IL-1).

What makes these drugs so different from other drugs used to treat RA

that modify the immune system (see the DMARDs article) is that biologics

affect a specific component of the immune system, not the entire immune

system. Thus, these drugs theoretically have fewer side effects.

What Are the Side Effects?

As with any drugs that suppress the immune system, biologic therapy

might pose some risks, since it could make your body more vulnerable to

other infections and diseases. Biologics may also cause some chronic

diseases in remission -- such as tuberculosis -- to flare up, and they

are often not recommended for people with multiple sclerosis and other

conditions.

Since biologic therapy is only in its early stages of use, some of the

long-term effects of using these medications simply aren't known, and

your doctor will probably want to regularly monitor your health while

using them. Biologics are also currently more expensive than

conventional systemic treatments. However, the evidence so far is that

they work well and pose fewer risks than other systemic therapies.

One disadvantage to biologic medication is that it has to be given

either by injection or by intravenous infusion; the latter approach can

take two hours per session. However, the advantages of these drugs

appear to be numerous.

Here are some details on each drug.

Enbrel

Enbrel reduces joint inflammation by blocking a cytokine called tumor

necrosis factor, or TNF.

Enbrel is given by injection under the skin twice a week. Many people

learn to give their own injections or receive them from a family member

who has received proper instruction. A kit is available from the

manufacturer that makes drawing up the medicine and injecting it easier.

Studies on Enbrel suggest that it may cause irritation at the injection

site. The studies so far have not revealed significant problems with

other side effects.

Pregnant women should not take Enbrel. Anyone with a serious infection

should stop taking Enbrel and resume it after being advised by a physician.

Humira

Humira blocks the cytokine tumor necrosis factor. The drug is an

injection that can be self-administered. It is usually taken once every

two weeks.

Some patients taking Humira to treat RA experience improvement within

two weeks of the initial dose.

Kineret

Kineret reduces joint inflammation by blocking the cytokine

interleukin-1. The drug is administered as one subcutaneous injection

daily (can be self-injected or given to you by another individual).

Improvement in symptoms will occur within four weeks, though it may take

up to 12 weeks for maximum benefit.

Remicade

Like Enbrel, Remicade reduces inflammation by blocking the cytokine

tumor necrosis factor. Remicade is given by intravenous infusion in the

doctor's office or hospital. Each infusion takes about two hours. The

intravenous treatments are given three times during the first six weeks

of therapy, then every eight weeks.

As with Enbrel, treatments may weaken the body's ability to fight

infection. If you have any signs of infection such as a fever over

100°F, sweats or chills, skin rash, or other symptoms that cause

concern, contact your doctor right away.

Researchers believe that future agents, still in the early development

stages, may be less expensive and will be taken orally. Also on the

horizon are biologics that target different cytokines.

With any treatment, it is important to meet with your physician

regularly so he or she can closely monitor you to detect the development

of any side effects and monitor your treatment if necessary. Your doctor

may periodically order blood tests or other tests to determine the

effectiveness of your treatment and the presence of any side effects.