RESEARCH - B-cell-targeted RA treatment works but infection risk rockets

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National Review of Medicine

July 30, 2004

Volume 1 No. 14

B cell-targeted RA treatment works but infection risk rockets

Rituximab reduces pain & swelling longterm but throws a wrench in the

immune system works

by Hoyle

Bill Nguyen is a 41-year-old artist who's passionate about his craft.

Lately he'd been frustrated. Rheumatoid arthritis (RA) had robbed him of the

ability to create his signature Chinese paintings, admired for their fine

detail. " I've tried so many treatments -- but nothing seems to last very

long. I sometimes think I'd give up the one hand if the other would just be

free of pain, " lamented Bill. While that trade isn't possible, a drug trial

published in the June 17 edition of the New England Journal of Medicine

(NEJM) offered hope of longterm relief. This benefit comes at a price

though -- a higher risk of infection.

Of the 121 patients who received two doses of rituximab -- a

monoclonal antibody that blocks the immune system's B cells -- during the

first two weeks of the study, 52 experienced a reduction in joint pain,

swelling and stiffness that lasted a full six months. Only five of the 40

patients who took conventional drugs had the same benefit. Further, this

pain relief lasted for the whole 48-week period of the study.

Tampering with the immune system, however, is a little like playing

with fire. Four of the 121 rituximab-treated patients became seriously ill

because their immune systems were weakened. This isn't unprecedented. In

fact, this particular Pandora's box " has been wide open in this respect for

many years, " said lead author Dr of University College,

London. " The most recent licensed treatments for RA are very

immunosuppressive and major infection has been a significant problem. With

rituximab the problem looks to be less severe but ongoing studies outside

the NEJM trial do tend to indicate the chest infection may be more common. "

It's still unclear whether repeated use of rituximab worsens the

immunosuppression. Similarly acting RA treatments don't ramp up

immunosuppression over time, but the jury is still out on rituximab. " This

may mean [it] cannot be given over a period of many years, but more work is

needed to address this, " said Dr .

" Whether the risk is outweighed by the benefit can only be judged by

the patients, " claimed Dr . " Different people have different views on

life and the relative merits of risk and freedom from chronic pain. People

with arthritis desperately want to be free of painful, sleepless nights and

fatigue and stiffness in the day. They also want to be free of the burden of

longterm drug treatment. This is what we should be aiming for. "

http://www.nationalreviewofmedicine.com/issue/2004_07_30/clinical02_14.html

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org