Biologic Drug for Early RA?

Study: Adding an Anti-TNF Biologic Drug May Help When Methotrexate Isn't Enough

By Miranda Hitti
WebMD Health News

Reviewed By Louise Chang, MD

Aug. 6, 2009 -- In a new study, rheumatoid arthritis researchers say they've found a good plan for treating rheumatoid arthritis in its early stages.

The study, published in The Lancet, included 487 adults in Sweden who had had rheumatoid arthritis (RA) for less than one year.

First, all of the patients took the drug methotrexate for three to four months. That was all that 145 patients -- about 30% -- needed to bring their rheumatoid arthritis symptoms to a low level.

The remaining patients continued taking methotrexate. Half of them also started taking two more pills -- sulfasalazine and hydroxychloroquine -- to treat their RA.

The other half added a biologic drug called Remicade, which is given intravenously. Remicade belongs to a class of drugs called tumor necrosis factor (TNF) inhibitors.

One year later, 39% of the patients taking methotrexate plus Remicade had only low levels of RA symptoms, compared to 25% of patients taking methotrexate plus sulfasalazine and hydroxychloroquine.

The difference between the two groups didn't happen right away; the Remicade-plus-methotrexate group took the lead after six months of treatment, note the researchers, who included R.F. van Vollenhoven, MD, of the rheumatology clinic at Sweden's Karolinska University Hospital.

Adverse events were "balanced fairly well between the two groups" and were in line with the drugs' known side effects, van Vollenhoven and colleagues note.

The researchers aren't recommending anti-TNF drugs for everyone with RA, because anti-TNF drugs are more expensive than conventional drugs and aren't always needed or appropriate.

The researchers are following the patients for a second year; those results haven't been published yet.

"The results provide further evidence of the value of biological agents," states an editorial published with the study. Aggressive treatment, with a goal of remission, is also important, note the editorialists, who included Tuulikki Sokka, MD, PhD, of Finland's Jyvaskyla Central Hospital.

The study didn't compare Remicade to other anti-TNF drugs. It was funded in part by Schering-Plough, the drug company that markets Remicade outside the U.S.

SOURCES: van Vollenhoven, R. The Lancet, Aug. 8, 2009; vol 374: pp 459-466. Sokka, T. The Lancet, Aug. 8, 2009; vol 374: pp 430-432.

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