New and emerging therapies for rheumatoid arthritis:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2004
|
| Series: | Rheumatic disease clinics of North America
30,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII S., S. 238 - 439 graph. Darst. |
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| 245 | 1 | 0 | |a New and emerging therapies for rheumatoid arthritis |c guest ed. Joel M. Kremer |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2004 | |
| 300 | |a XII S., S. 238 - 439 |b graph. Darst. | ||
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CONTENTS
Preface xi
Joel M. Kremer
Safety Overview of New Disease Modifying
Antirheumatic Drugs 237
John J. Cush
Beginning in 1998, a surge of new agents has expanded treatment
options for rheumatoid arthritis (RA) patients. Although the disease
modifying potential of these agents is encouraging, their use must be
weighed against an evolving array of new safety concerns. Because
of the popularity of these agents with patients and rheumatologists
alike, clinicians must be prepared to discuss the potential risks asso¬
ciated with novel disease modifying antirheumatic drugs and bio¬
logic therapies as they begin to appear with greater frequency in
practice. This article discusses the safety issues arising from clinical
trial and postmarketing experience with several new and commonly
used agents, with specific emphasis on adalimumab, etanercept,
infliximab, anakinra, and leflunomide.
Consideration of the Risk and Treatment of Tuberculosis
in Patients Who Have Rheumatoid Arthritis and Receive
Biologic Treatments 257
Jeffry Bieber and Arthur Kavanaugh
Evidence supports the association of tuberculosis (TB) with tumor
necrosis factor inhibitor therapy in patients who have rheumatoid
arthritis. There seem to be differential risks of TB with the cur¬
rently available inhibitors. Screening for latent TB infection with
purified protein derivative is indicated for patients who are being
considered for treatment; it seems to be effective in reducing the
occurrence of TB in treated patients.
VOLUME 30 • NUMBER 2 • MAY 2004 v
Associations Between Rheumatoid Arthritis and Malignancy 271
Eliza F. Chakravarty and Mark C. Genovese
There are many complex associations between rheumatoid arthri¬
tis (RA) and malignancy. Patients with rheumatic diseases on the
whole appear to be at increased risk for the development of
certain malignancies. The data from several studies are persuasive
that the presence of RA conveys an increased risk for the devel¬
opment of lymphoproliferative disorders and may convey a
decreased risk for the development of malignancies of the diges¬
tive tract. Understanding the complex interrelationships between
RA and malignancy will lead to more accurate diagnosis of under¬
lying pathology more effective treatment of symptoms and
underlying disease, and appropriate surveillance for the develop¬
ment of later complications.
Overview of Radiologic Efficacy of New Treatments 285
D.M.F.M. van der Heijde
Randomized, double blind trials on new treatments, including
anakinra, etanercept, infliximab, and leflunomide, show convincing
reduction in radiographic progression. The relative efficacy of these
new treatments is unknown. Head to head comparisons have not
been performed and comparing treatment arms across trials has
several pitfalls. These possible pitfalls are discussed.
Leflunomide 295
Grant W. Cannon and Joel M. Kremer
Leflunomide is a low molecular weight, synthetic, oral agent
specifically developed for immunosuppression. Because of activity
in animal models, leflunomide was tested in rheumatoid arthritis
(RA). These investigations have demonstrated that leflunomide
reduces the clinical symptoms and signs of RA, improves health
related quality of life, and retards structural damage. Leflunomide
has been evaluated in RA patients as monotherapy and in combi¬
nation with methotrexate. Close monitoring for adverse events
with particular attention for monitoring liver enzymes for hepatic
toxicity is important during treatment with leflunomide.
Treatment of Rheumatoid Arthritis with Etanercept 311
Mark C. Genovese and Joel M. Kremer
Etanercept is effective in the treatment of rheumatoid arthritis (RA)
when used as monotherapy and in combination with methotrexate
(MTX). Radiographic progression of disease was slowed signifi¬
cantly when the drug was used for a 24 month period and was sta¬
tistically significantly better than MTX. In addition to its use in RA,
etanercept is approved by the U.S. Food and Drug Administration
for other rheumatologic conditions, including psoriatic arthritis,
ankylosing spondylitis, and juvenile chronic arthritis.
Infliximab Treatment of Rheumatoid Arthritis 329
Sir Ravinder Maini
Infliximab was the first anti TNF agent used to treat rheumatoid
arthritis to provide proof of concept of the role of TNF a in this
condition. It has become widely used since, principally as an effective
treatment in combination with methotrexate, but also as monother
apy for the treatment of Crohn s disease, ankylosing spondylitis,
and psoriatic arthritis. The benefits of infliximab in controlling
signs and symptoms, improving quality of life, preventing struc¬
tural joint damage, and possible healing of bone provide an impor¬
tant option for the treatment of rheumatoid arthritis.
Adalimumab Therapy in Rheumatoid Arthritis 349
Edward Keystone and Boulos Haraoui
Adalimumab is a recombinant human immunoglobulin Gl mono¬
clonal antibody that is specific for human tumor necrosis factor.
Based on the data presented in this article, adalimumab adminis¬
tered alone or in patients partially responsive to methotrexate
exhibits a rapid onset of action, provides a substantial reduction in
signs and symptoms, and results in an improvement in physical
function and health related quality of life. Adalimumab has been
demonstrated to inhibit progression of structural joint damage
in patients who have long standing rheumatoid arthritis. Taken
together, the data support adalimumab as a new therapeutic option
for patients with moderate to severe rheumatoid arthritis.
The Use of Anakinra, an Interleukin 1 Receptor Antagonist,
in the Treatment of Rheumatoid Arthritis 365
Stanley B. Cohen
Interleukin 1 (IL 1) is a primary cytokine that is involved in the
pathogenesis of rheumatoid arthritis; it contributes to inflamma¬
tion and joint destruction. Anakinra (Kineret) is an IL 1 receptor
antagonist that blocks the biologic activity of IL 1. It was approved
by the U.S. Food and Drug Administration (FDA) for the treatment
of rheumatoid arthritis in 2001. Anakinra is safe and effective in the
treatment of rheumatoid arthritis, both as monotherapy and in
combination with other disease modifying antirheumatic drugs.
This article reviews the preclinical, clinical, and postmarketing data
on the safety and efficacy of anakinra in the treatment of rheuma¬
toid arthritis and focuses on the pivotal clinical trials that led to
FDA approval.
Cytotoxic T Lymphocyte Antigen 4 Immunogolbulin
in Rheumatoid Arthritis 381
Joel M. Kremer
It is apparent that the potential to significantly affect the immune
response exists through artificial modulation of a system of mole¬
cules on the surface of T cells that has been designed to specifically
provide on off switches to support or abrogate the activation of T
cells. This approach holds considerable promise because it avoids
toxicities associated with cell lysis, while theoretically specifically
affecting only those T cells, which are being continuously stimulated
to become activated. Although there is presently a paucity of studies
in humans on the clinical effects of cytotoxic T lymphocyte antigen
4 immunoglobulin in patients who have rheumatoid arthritis, the
existing studies indicate a clear therapeutic value with this approach.
B Lymphocyte Depletion Therapy with Rituximab
in Rheumatoid Arthritis 393
J.C.W. Edwards, M.J. Leandro, and G. Cambridge
B lymphocyte depletion therapy in rheumatoid arthritis can provide
major clinical benefits. Widespread use in the future will depend on
continued evidence of safety, particularly in the context of long
term use. Rituximab is a highly effective agent, but it may be best
used in combination with other agents. Substantial improvement
following a single course of therapy has been found to last up to 42
months, and it is reasonable to hope that further development of
strategies targeting B cells will extend this toward the original aim
of truly long term remission.
Clinical Experience with Inhibition of Interleukin 6 405
Ernest Choy
Rheumatoid arthritis (RA) is a systemic disease that is associated
with increased mortality and morbidity. Prognosis depends on
disease severity and response to treatment. Those patients whose
diseases are refractory to treatment with disease modifying anti
rheumatic drugs (DMARDs) and have persistent inflammation
have reduced survival similar to patients with triple vessel coro¬
nary artery disease and Hodgkin s lymphoma. Although DMARDs
reduce inflammation and improve symptoms, they do not improve
long term prognosis. Chronic synovial inflammation results in
damage to the articular cartilage and adjacent bone. Consequently,
after 10 years of disease most patients develop significant disability
due to joint damage. Interleukin 6 (IL 6) is a key mediator of inflam¬
mation in RA. Inhibition of IL 6 reduces synovitis and improves
symptoms. Therapies targeting IL 6 are promising new treatments
for RA.
Interleukin 18 and the Treatment of Rheumatoid Arthritis 417
Charles A. Dinarello
Interleukin (IL) 18 is a new member of the IL 1 family of proin
flammatory cytokines. Based on preclinical studies in animals, IL 18
likely plays a role in rheumatoid arthritis, and strategies to block
IL 18 activity are underway in clinical trials. In one of these trials,
a naturally occurring IL 18 binding protein (IL 18BP) binds IL 18
with a high affinity and reduces disease severity in models of
inflammatory diseases. IL 18BP is not the soluble receptor for IL 18
but rather a distinct molecule, which appears to be distantly related
to the IL 1 receptor type II, both structurally and functionally, and
hence represents part of the IL 1 family of receptors.
Index 435
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| spelling | New and emerging therapies for rheumatoid arthritis guest ed. Joel M. Kremer Philadelphia [u.a.] Saunders 2004 XII S., S. 238 - 439 graph. Darst. txt rdacontent n rdamedia nc rdacarrier Rheumatic disease clinics of North America 30,2 Geneesmiddelen gtt Reumatoïde artritis gtt Therapieën gtt Antirheumatic Agents Arthritis, Rheumatoid Rheumatoide Arthritis (DE-588)4076708-5 gnd rswk-swf Therapie (DE-588)4059798-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Rheumatoide Arthritis (DE-588)4076708-5 s Therapie (DE-588)4059798-2 s b DE-604 Kremer, Joel M. Sonstige oth Rheumatic disease clinics of North America 30,2 (DE-604)BV000625464 30,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=012795033&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | New and emerging therapies for rheumatoid arthritis Rheumatic disease clinics of North America Geneesmiddelen gtt Reumatoïde artritis gtt Therapieën gtt Antirheumatic Agents Arthritis, Rheumatoid Rheumatoide Arthritis (DE-588)4076708-5 gnd Therapie (DE-588)4059798-2 gnd |
| subject_GND | (DE-588)4076708-5 (DE-588)4059798-2 (DE-588)4143413-4 |
| title | New and emerging therapies for rheumatoid arthritis |
| title_auth | New and emerging therapies for rheumatoid arthritis |
| title_exact_search | New and emerging therapies for rheumatoid arthritis |
| title_full | New and emerging therapies for rheumatoid arthritis guest ed. Joel M. Kremer |
| title_fullStr | New and emerging therapies for rheumatoid arthritis guest ed. Joel M. Kremer |
| title_full_unstemmed | New and emerging therapies for rheumatoid arthritis guest ed. Joel M. Kremer |
| title_short | New and emerging therapies for rheumatoid arthritis |
| title_sort | new and emerging therapies for rheumatoid arthritis |
| topic | Geneesmiddelen gtt Reumatoïde artritis gtt Therapieën gtt Antirheumatic Agents Arthritis, Rheumatoid Rheumatoide Arthritis (DE-588)4076708-5 gnd Therapie (DE-588)4059798-2 gnd |
| topic_facet | Geneesmiddelen Reumatoïde artritis Therapieën Antirheumatic Agents Arthritis, Rheumatoid Rheumatoide Arthritis Therapie Aufsatzsammlung |
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