Navigation Links
Tweaking withdrawal of rheumatoid arthritis medications before surgeries may reduce disease flares
Date:11/5/2011

As guidelines recommend, doctors appear to be stopping anti-TNF medications before surgery, but may be doing so far sooner than is necessary, according to a new study by researchers at Hospital for Special Surgery. These medications are used to treat a variety of inflammatory diseases, including rheumatoid arthritis, and better timing of withdrawal prior to surgery might minimize the risk of disease flares.

"We need to do more studies to see if more pharmacologically-based timing of when you hold these medicationsmaybe tie it more to their half lifemight potentially decrease rates of postoperative flares," said Lisa Mandl, M.D. MPH, a rheumatologist at HSS. She is principal investigator of the study that will be presented on Nov. 8 at the American College of Rheumatology's annual meeting.

Anti-tumor necrosis factor (anti-TNF) medications are increasingly being used in patients with rheumatoid arthritis (RA) due to their effectiveness. Because these medications suppress the immune system, guidelines recommend stopping anti-TNF therapy before any type of surgery. Few studies, however, have examined what happens in actual practice or the effect of stopping medications on patients.

To investigate the issue in knee replacement surgery, a common surgery in RA patients, researchers utilized data from the HSS Total Joint Replacement Registry. This prospective registry started in 2007 includes, among other things, data on all patients who seek care at HSS for a total knee replacement (TKR). "Other institutions may have similar registries, but we do such a high volume of surgeries that other people might take decades to get what we do in a few years. We have large numbers and it is a contemporary registry, so it's not 10,000 patients over the last 20 years. It is 20,000 over the last five years," Dr. Mandl said. The database gives doctors a snapshot of what is happening in present day practice.

Through a retrospective chart review of patients in this registry who had undergone a TKR between June 2007 and May 2010, HSS researchers identified 194 patients with RA. Cases were identified by medical billing code (ICD-9) or self-report, and then confirmed by chart review; 86 (41.4%) used anti-TNFs, predominantly etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). When investigators checked the charts, they found that 86 percent of them documented that anti-TNFs should be held and 74 percent identified a specific stop time.

While the recommended stop time should have been based on the half-life of the medications (how long the medicines stay in the body), the data did not show this to be the case. For individuals on etanercept, which has a half-life of 3 to 5.5 days, the average stop time was 2.4 weeks prior to surgery. For adalimumab, which has a half-life of 1.4 to 2.9 weeks, the average stop time was 4.6 weeks. For infliximab, which has a half-life of 1 to 1.7 weeks, the average stop time was 4.9 weeks.

All patients in the HSS Total Joint Replacement Registry receive a six-month adverse events survey and, for this study, an additional survey was sent to patients if they had not yet replied to maximize response rates. Study participants also received an RA specific questionnaire that collected information such as how long they had been impacted by the disease and whether they had any arthritis flares after surgery.

Investigators analyzed self-reported flares within one month of surgery as well as six-month adverse events, including surgical site infection, pulmonary embolism, deep venous thrombosis, re-operations, and infections such as pneumonia. They found no statistically significant difference in adverse events between patients who received anti-TNFs and those who did not. The self-reported RA flare rate was higher in the anti-TNF groups (22.4% vs. 16.9%), although this difference was not statistically significant (P=0.47).

"At least in this relatively small sample, it doesn't look like there are any increases in infections or blood clots or other problems that go along with these anti-TNFs, which is comforting for patients who are on these drugs who are going in for surgery," Dr. Mandl said.

She said that more work should be done to evaluate if the half-lives of the medications should be considered more carefully when determining when to pull the drugs from patients before a procedure. "Maybe we won't have to stop patients so early," Dr. Mandl said. "We need to think a little bit more about how we hold them to optimize how patients do after surgery."


'/>"/>

Contact: Phyllis Fisher
phyllis.fisher@gmail.com
212-606-1197
Hospital for Special Surgery
Source:Eurekalert

Related medicine news :

1. Withdrawal of CPAP therapy results in rapid recurrence of OSA
2. Smoking Withdrawal Shows Up in Brain Mood Centers
3. New clinical trial to examine medication to treat social withdrawal in Fragile X and autism
4. Kids ER Visits Down After Cold Medicine Withdrawal
5. Decade-long trial confirms benefts of steroid withdrawal for transplant patients
6. Impact of Azmacort Withdrawal Brought to Light in Medicine Community
7. Nicotine Withdrawal Can Complicate Hospital Care
8. Mayo Clinic: Young women with rheumatoid arthritis at more risk for broken bones
9. TNF Treatment for Rheumatoid Arthritis Boosts Skin Cancer Risk
10. Inflammation From Rheumatoid Arthritis Tied to Heart Disease
11. Some Drugs for Rheumatoid Arthritis, Psoriasis May Cut Diabetes Risk
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... 2016 , ... As a lifelong Southern Californian, Dr. Omkar Marathe earned his ... David Geffen School of Medicine at UCLA. He trained in Internal Medicine at Scripps ... in hematology/oncology at the UCLA-Olive View-Cedars Sinai program where he had the opportunity to ...
(Date:6/24/2016)... ... ... A recent article published June 14 on E Online details ... to state that individuals are now more comfortable seeking to undergo not only the ... and cheek reduction. The Los Angeles area medical group, Beverly Hills Physicians (BHP) notes ...
(Date:6/24/2016)... ... June 24, 2016 , ... The Pulmonary ... Dallas that it will receive two significant new grants to support its work ... marked its 25th anniversary by recognizing patients, medical professionals and scientists for their ...
(Date:6/24/2016)... ... , ... Topical BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief Products, join The ‘Business ... to $12 an hour by 2020 and then adjusting it yearly to increase at the ... minimum wage, assure the wage floor does not erode again, and make future increases more ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... ... client, The Grove Investment Group (TGIG), has initiated cultivation and processing operations at ... Las Vegas and Pahrump, Nevada. , Puradigm is the manufacturer of a complete ...
Breaking Medicine News(10 mins):
(Date:6/26/2016)... DUBLIN , June 27, 2016 Jazz ... the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act ... proposed acquisition of Celator Pharmaceuticals, Inc. ("Celator"; Nasdaq: ... 11:59 p.m. (Eastern Daylight Time). As previously ... entered into a definitive merger agreement under which Jazz ...
(Date:6/24/2016)... HILL, N.C. , June 24, 2016 /PRNewswire/ ... healthcare decisions and regulators/payers have placed more emphasis ... new environment, patient support programs in the pharmaceutical ... for patients, medications. Consequently, pharmaceutical companies are focusing ... ensure they are providing products and services that ...
(Date:6/24/2016)... , June 24, 2016   Bay Area ... Network,s Dean Center for Tick Borne Illness ... and Rehabilitation, MIT Hacking Medicine, University of California, ... today announced the five finalists of Lyme ... disease.  More than 100 scientists, clinicians, researchers, entrepreneurs, ...
Breaking Medicine Technology: