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Newer RA Drugs May Reduce Heart Risk

Downside to Biologics Is Lower Immunity, Increased Risk of Shingles, Others Find
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WebMD Health News

June 8, 2012 -- Rheumatoid arthritis patients who take medications known as anti-TNFs may be treating more than their disease. According to new research presented at a European meeting, these patients may be less likely to have a heart attack and are more likely to live longer than those with RA who are not taking the drugs.

In one study, the longer the patients take the anti-TNF drugs, the more protected they are from heart attacks.

"The unique feature of this study is, we have tied the time on the drugs with the reduction of heart attacks and other problems," says researcher Michael Nurmohamed, MD, PhD, of the VU University Medical Centre and Jan van Breemen Research Institute in Reade, Netherlands.

"After one year on anti-TNFs, we saw a 24% reduction, after two years, 42%, and after three years, 56%, compared to those not on the drugs," he tells WebMD.

He presented the findings this week at EULAR 2012, the Annual Congress of the European League Against Rheumatism. The study was funded by Abbott, which makes the anti-TNF drug Humira.

At the same meeting, other researchers also reported those on biologic treatments (such as anti-TNFs) have a reduced risk of death compared with those treated with traditional RA drugs.

Other researchers found earlier control and resolution of disease activity reduced the risk of death.

Not all of the research was positive, though. In a fourth study, researchers reported an increased risk of getting shingles while on the anti-TNF drugs. The often painful condition is caused by the herpes zoster virus in adults.

RA & RA Drugs

About 1.3 million Americans have RA, in which inflammation of the joints and surrounding tissue can cause pain and stiffness.

Drugs known as disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex, Trexall), are typically prescribed first.

If they don't give enough relief, other drugs, including anti-TNFs, are often added. Among them: Cimzia (certolizumab), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), and Simponi (golimumab).

Anti-TNF drugs belong to a class known as biologics, which are designed to inhibit parts of the immune system that cause inflammation.

DMARDs cost about $45 to $120 a month. Anti-TNF drugs, given intravenously or injected, cost about $1,700 a month or more, according to the American College of Rheumatology.

Anti-TNFs & Heart Attacks Study

In his study, Nurmohamed evaluated nearly 110,000 patients with RA on various types of RA drugs.

He then calculated risk reduction with the anti-TNF drugs.

The reduced risk for heart attacks, he says, is tied to suppressing inflammation.

"We know now that inflammation is important for atherosclerosis," so suppressing it is good not only for the RA but for heart attack risk reduction, he says.

"The take-home message is that disease activity should be reduced a much as possible, first by DMARDS. If that is not enough, biologics should be considered from a cardiovascular point of view."

Nurmohamed reports speaker's fees and consultant work for Abbott and other pharmaceutical companies.

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