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Expensive Meds Best for Rheumatoid Arthritis?

High-Priced Remicade Shows Promise in Newly Diagnosed Patients, Study Shows
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WebMD Health News

Jan. 10, 2005 -- Newly diagnosed rheumatoid arthritis (RA) patients may get the most benefit from effective but high-priced medications, a British study shows.

An autoimmune disease, RA is a leading cause of disability. It involves inflammation of joints and surrounding tissues. Over time, rheumatoid arthritis can destroy joints' cartilage, ligaments, tendons, and bone. In some cases, it can also damage the body's organs.

Drugs are available to treat rheumatoid arthritis. But some of the newest, most effective medications are costly. In fact, they're so expensive that it's not practical for most patients to take them for a lifetime. Remicade's annual tab is $12,000 for an average of eight treatments, according to the National Psoriasis Foundation.

That weighed on the mind of British researcher Mark Quinn, MBChB, MRCP. He worked with colleagues from England's Leeds General Infirmary to look for ways to reap the drugs' benefits without going broke. Their study appears in the January issue of Arthritis & Rheumatism.

Quinn focused on two drugs: methotrexate and Remicade. Since there is no cure for rheumatoid arthritis the goal is to treat the disease early to prevent disabling pain and permanent damage to joints.

Methotrexate is the mainstay of rheumatoid arthritis treatment. Originally prescribed as a cancer chemotherapy drug, methotrexate is used in lower doses to attack the overactive immune system cells that damage joints in RA.

Remicade is a newer drug and tames the inflammation associated with RA by targeting a protein called tumor necrosis factor. Remicade is usually taken with methotrexate. Both methotrexate and Remicade can slow progression of RA.

Remicade and the similar drug Enbrel have also had success against other inflammatory conditions including Crohn's disease, ankylosing spondylitis, psoriasis, and psoriatic arthritis, say the researchers.

The study was small, with 20 newly diagnosed rheumatoid arthritis patients. They were about 52 years old, with symptoms present for less than a year before the study began.

All participants received methotrexate. In addition, half took Remicade along with methotrexate. The remaining participants received a placebo instead of Remicade. They were not aware if they were receiving Remicade or a placebo. Participants took their drugs for a year.

After a year, everyone had improved to some degree. MRI scans showed a significant reduction in joint problems.

But relief came faster, lasted longer, and improved life more for the Remicade group. Their MRI scans showed no new signs of joint erosion after a year. They also had greater gains in function and quality of life, starting at 14 weeks and lasting throughout the study.

Treatment with Remicade resulted in a rapid decrease of the blood inflammatory marker C-reactive protein (CRP), which indicates decreased inflammation and less potential for joint damage.

Those improvements didn't vanish overnight. Function and quality-of-life improvements lasted a year after the patients had stopped taking the drugs.

That surprised the researchers. Previous studies showed that rheumatoid arthritis quickly reared back up when patients stopped taking drugs like Remicade, they say.

Larger studies are already underway to double-check the results. While the findings need confirming, they indicate that early treatment with Remicade and other similar drugs may be the best option.

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