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New Therapy for Rheumatoid Arthritis

In this article, doctors from the Northwestern University School of Medicine in Chicago review recent advances in drug therapy for rheumatoid arthritis (RA). New biologic agents designed to affect the immune system at the cellular level are being developed. Tocilizumab, Abatacept, and Rituximab are discussed in detail.

Tocilizumab is a monoclonal antibody. In trials with RA patients, 78 percent got at least 20 percent better. Side effects included increased cholesterol levels and abnormal liver function. Only short-term results (three months) are available so far. Tocilizumab works by itself but also works better when combined with methotrexate (MTX). MTX is a commonly used drug for RA.

Abatacept acts like an antibody. It attaches itself to a protein on the surface of T-lymphocytes (T-cells) and prevents the start up of T-cells. The effect is to stop the RA disease process. It is used for patients who have not had good results with disease modifying antirheumatic drugs (DMARD) therapy. Serious infections is a side effect of abatacept.

Rituximab is an anticancer drug that has been approved for use in RA patients who have not been helped by other drug therapies. It works by stopping B cells in the immune system. In a study of patients already taking MTX, the positive effects of rituximab lasted 48 weeks. The drug was given by IV. The only problem was a reaction in about one-third of the patients during the first infusion.

As research continues, progress will be made in treating patients with RA. It's likely that today's drugs will be used in combination with future biologic agents. The goal is to get the positive benefit of the drug without the negative side effects. For right now, it looks as though MTX and TNF-alpha antagonists will remain the standard treatment for RA.

References: Nimesh A. Dayal, MD, and Eric M. Ruderman, MD. Advances in RA: The Next Generation of Therapies. In The Journal of Musculoskeletal Medicine. May 2006. Vol. 23 No. 5 Pp. 337-346.

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