ATLANTA, Georgia-- Two new drugs can halt the progression of rheumatoid arthritis and lessen damage to the joints, according to two studies appearing Wednesday in the New England Journal of Medicine.
"This is the first time we have evidence that a drug can actually lessen joint damage in rheumatoid arthritis," said Dr. John Klippel of the Arthritis Foundation. "It hasn't been clear that drugs can do this."
One study looked at the drug Enbrel and found that it decreased symptoms and slowed joint damage more rapidly in patients who were recently diagnosed with rheumatoid arthritis when compared to the drug methotrexate, which is considered the gold standard in arthritis treatment.
Those patients treated with injections of Enbrel twice a week also had fewer side effects and infections compared to the methotrexate group. The second study looked at patients who were taking methotrexate but still had arthritis symptoms. When these patients took the drug Remicade in addition to methotrexate, signs and symptoms of the disease were reduced. The progression of joint damage was also halted in patients taking both medications.
The U.S. Food and Drug Administration approved both Enbrel and Remicade two years ago for rheumatoid arthritis patients who had failed methotrexate. The two drugs work by binding with tumor necrosis factor (TNF), a protein that causes the inflammation that leads to joint destruction. The drugs neutralize TNF before it can cause joint damage.
Although the drugs cannot cure the disease, some patients have gone into remission. "These studies show many more patients can benefit from taking these two drugs," said Klippel. "Even though the FDA expanded the indications for their use earlier this year to include patients with moderate to severe disease, many patients are not using them."
There are several reasons why doctors have been reluctant to prescribe the drugs. For one, there has been more information available about the long-term use of methotrexate and its potential side effects compared to the newer drugs. Several other new therapies have been approved for rhematoid arthritis but have not been compared to Enbrel and Remicade.
"Cost is also an issue," said Klippel. "The newer drugs cost $10-12 thousand a year, which is far greater than methotrexate. But that cost has to be weighed against keeping patients active longer and enabling them to stay in the workforce longer."
The new TNF-inhibitors have few side effects and some doctors say they should be used as early as possible in all patients who have been diagnosed with rheumatoid arthritis. About 2.1 million Americans suffer from this chronic disease, which can cause substantial joint damage and disability.