New era in rheumatoid arthritis treatment? scientists claim
A “new era” has started in the treatment of rheumatoid arthritis, according to scientists writing in the scientific journal The Lancet.
The article highlights the importance of three drugs; rituximab, abatercept and tociluzumab for patients with severe rheumatoid arthritis, whose symptoms are not controlled by anti-TNF therapy.
Professor Alan Silman, medical director of the Arthritis Research Campaign, said: “While the advent of these new drugs is exciting, the real revolution in new treatment for rheumatoid arthritis started several years earlier with the discovery of anti-TNF therapy. That research, much of it performed by Arthritis Research Campaign scientists, identified the complex process of what caused inflammation in rheumatoid arthritis.
"The three drugs highlighted in The Lancet result from that increased knowledge and more new therapies will follow in the next few years as pharmaceutical companies continue to exploit these research findings.
“Rituximab, abatercept and tocilizumab will all be used in patients who fail on anti-TNF therapy (about 30 per cent of patients) so offer more potential choice for patients with severe disease , for whom at present there are no real alternatives. The results for these three drugs in such treatment-resistent patients are useful though not staggering, and they may play a more useful role if given early in disease as an alternative to anti-TNF therapy. However more research is needed both about their effectiveness and, equally important about their safety in long term large scale studies,” added Professor Silman.
Of the three drugs, rituximab (brand name Mabthera) is licensed in Europe but is still awaiting approval by NICE, abatercept (Orencia) gained its license within the past couple of weeks, while tociluzumab (Actemra) is in phase III trials.
Rituximab targets the CD20 antigen expressed in the body’s B-cells. It has been used for several years to treat non-Hodgkin’s lymphoma. Abatercept works by interfering with the T-cell response, which is vital in the mechanism of rheumatoid arthritis.
Tocilizumab targets interleukin-6, which activates many cell populations. All have shown good results in trials. Side effects varied and included infusion reactions, infections, headaches and fever.
Professor Josef Smolen from the Division of Rheumatology, Medical University of Vienna in Austria (who has been funded by the pharamaceutical companies which manufacture the drugs) and colleagues, including arc Professor of Rheumatology at the University of Leeds, Paul Emery, conclude in The Lancet by saying: “The many patients who obtain insufficient responses to established and novel treatments indicate the need to search for further therapies and treatment principles to increase response rates, and to achieve high frequencies of remission or even cure in rheumatoid arthritis. The prospects are here.”
