Abatacept: Promising New Treatment For Rheumatoid Arthritis

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Promising Treatment For Rheumatoid Arthritis

http://abclocal.go.com/kgo/story?section=edell & id=4475146

Rheumatoid arthritis is a painful, chronic disease that affects about two

million Americans. There are some drugs available to help the pain, but not

all patients will benefit. Now there's a new treatment that works

differently.

For 35 years, the simple act of walking was a struggle for Barbara.

Barbara D'Amico, rheumatoid arthritis patient: " Sometimes, I didn't even

sleep it was so painful. "

Barbara has rheumatoid arthritis -- a disease where her immune system

attacks her joints. She used to take up to 20 pain pills a day.

Barbara D'Amico: " Physically, I feel like it's a broken bone that never

heals. It's just a constant ache. "

Now Barbara is taking part in a clinical trial at Stanford using a new type

of treatment.

There are lots of different drugs for rheumatoid arthritis, but they don't

work for everyone. Stanford researchers are trying a new intravenous

treatment called abatacept. It inhibits the overactive immune system in

which the body attacks itself.

Rheumatologist Mark Genovese says standard treatments can lose their benefit

over time, but abatacept works when others have failed.

Mark Genovese, M.D., Stanford University Rheumatologist: " For many patients,

it means they'll have a better quality of life. They'll be able to function

better. They'll have a better emotional state. "

In a clinical study, half of the patients who took abatacept reported

relief.

Dr. Genovese: " It's a huge benefit to believe that you can get 50-percent of

your patients to have a significant improvement in their disease when in

affect, they have tried and failed existing therapies in the past. "

It's the only therapy that worked for Barbara. A few months ago, exercise

was painful, but not today.

Barbara D'Amico: " I couldn't make a fist, you know. Now, I can make a fist.

I can move my arms. I couldn't go up like this. "

And now she can be as active as she wants.

Abatacept is not yet FDA approved, but Dr. Genovese hopes that will happen

in the next couple of months. There is a risk of infection with the

treatment. Researchers are also testing the drug on patients with lupus.

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Research Summary: Rheumatoid Arthritis

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BACKGROUND: About 2 million Americans suffer from rheumatoid arthritis or RA

for short. RA is a process where the immune system attacks the body's

joints. The disease can lead to long-term joint damage, resulting in chronic

pain, loss of function and disability. Because it is a chronic disease, RA

may never go away. Frequent flares in disease activity can occur. RA is a

systemic disease, which means it can affect other organs in the body. Early

diagnosis and treatment of RA is critical for patients to live productive

lives. Studies show early aggressive treatment of RA can limit joint damage,

which in turn, limits loss of movement, decreased ability to work, higher

medical costs and potential surgery.

SYMPTOMS: RA can start in any joint, but it most commonly begins in the

smaller joints of the fingers, hands and wrists. Joint involvement is

usually symmetrical, meaning that if a joint hurts on the left hand, the

same joint will hurt on the right hand. Symptoms of rheumatoid arthritis

include fatigue, stiffness, weakness, swelling, flu-like symptoms, pain,

loss of appetite, depression and weight loss.

STANDARD TREATMENTS: There are many different medications available to treat

RA. Some of those include:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) These drugs are used to

reduce inflammation and relive pain. These are medications such as aspirin,

ibuprofen, indomethacin and COX-2 inhibitors such as valdecoxib and

celecoxib.

Analgesic Drugs These drugs relieve pain but don't necessarily have an

effect on inflammation. Examples include acetaminophen, propoxyphene and

morphine.

Glucocorticoids or Prednisone These are prescribed in low maintenance doses

to slow joint damage caused by inflammation.

Disease Modifying Antirheumatic Drugs (DMARDs) These are used with NSAIDs

and/or prednisone to slow joint destruction. Examples include methotrexate,

injectable gold and penicillamine.

Biologic Response Modifiers These drugs directly modify the immune system

by inhibiting proteins called cytokines, which contribute to inflammation.

Examples are etanercept, infliximab, adalimumab and anakinra.

Protein-A Immunoadsorption Therapy This is not a drug, but a therapy that

filters your blood to remove antibodies and immune complexes that promote

inflammation.

A NEW APPROACH: While current therapies may work for some patients, they

don't work for all. Also, some of the therapies can lose their

effectiveness. Now, researchers from Stanford University Medical Center in

Palo Alto, Calif., are studying a new treatment. The treatment is called

abatacept and it's given through an IV infusion. In a clinical study, the

treatment was given every two weeks and then once a month for six months.

Mark Genovese, M.D., says, " It is what we call a selective co-stimulatory

modulator. It is a protein. It's designed to specifically inhibit one of the

signals that's used to communicate with the immune system & It

down-regulates the immune system, so you get less activation of a certain

type of T-cell. "

GOOD RESULTS: In a study published in the New England Journal of Medicine,

researchers found patients, on average, experienced a 50-percent improvement

over six months. Dr. Genovese says, " It is a huge benefit to believe that

you can get 50 percent of your patients to have a significant improvement in

their disease when, in affect, they had tried and failed existing therapies

in the past. " So far, only mild side effects such as the risk of infection

have been noted with abatacept. Dr. Genovese says the drug is currently

awaiting FDA approval. If it does receive approval, he says it may be on the

market in 2006.