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Three New Drugs Mark New Era in Rheumatoid Arthritis Treatment

n a third of patients.

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Issued by Tim Duffy, Acting North American Editorial and Press Coordinator, The Lancet

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Abatacept works by interfering in the T-cell activation response, viewed as vital in the mechanism of RA. A trial combining abatacept at 10 mg per kg bodyweight for patients with their existing methotrexate treatment also found a reduction of RA symptoms of around 50% in some 40% of patients. This effect was much more pronounced than in patients given placebo instead of abatacept.

Tocilizumab targets interleukin-6, which is known to activate many cell populations. As with abatacept, combining tocilizumab with methotrexate reduced RA symptoms (in a phase II trial) by 50% in more than 40% of the patients.

Side effects vary between the drugs. Infusion reactions occurred in 30–35% of rituximab patients on first infusion, and rates of serious infections were higher with rituximab patients than those given placebo. Patients taking abatacept had higher incidence of headache, dizziness and serious infections than placebo. And some patients taking tocilizumab experienced headache and skin eruptions, stomatitis, fever, and increases in cholesterol levels and liver enzymes compared to placebo in phase II trials.

The authors conclude by saying all three new drugs diminish signs and symptoms of RA and improve physical function and health status, and retard progression of joint damage—thus expanding the range of treatments to fight RA.

But they conclude: "The many patients who obtain insufficient responses to established and novel treatments indicate the need to search for further therapies and treatment
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