Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Combining medications often best strategy to battle rheumatoid arthritis

20.11.2007
For patients with rheumatoid arthritis, combining one well-known, lower-cost synthetic drug with one of six biologic medications often works best to reduce joint swelling or tenderness, according to a new report by researchers at the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, which is sponsored by the Agency for Healthcare Research and Quality.

An article based on the report was posted on-line Monday in the Annals of Internal Medicine.

Researchers reviewed published evidence to compare the benefits and harms of three classes of medications: synthetic disease-modifying antirheumatic drugs (DMARDS), biologic DMARDs, and corticosteroids. Synthetic DMARDS include hydroxychloroquine, leflunomide, methotrexate, and sulfasalazine; biologic DMARDS include abatacept, adalimumab, anakinra, etanercept, infliximab, rituximab; and corticosteroids include drugs such as prednisone.

The report concluded that combining methotrexate, a synthetic DMARD, with one of the biologic DMARDs works better than using methotrexate or a biologic DMARD alone. The report also found that methotrexate works as effectively as the biologic DMARDs adalimumab and etanercept for patients who have early rheumatoid arthritis. Adalimumab and etanercept are more likely, however, to show better short-term results as measured by X-rays of joints. The report also emphasized that biologic DMARDs and methotrexate increase the risk of serious infection, including a reoccurrence of tuberculosis.

“Rheumatoid arthritis is a painful, degenerative disease that affects people of all ages and can profoundly impact quality of life,” said AHRQ Director Carolyn M. Clancy, M.D. “This report establishes a clear, unbiased summary of what is known about current treatments. It also identifies areas where more research is needed.”

About 2 million Americans have rheumatoid arthritis, a long-term illness that causes joint and tissue inflammation. Rheumatoid arthritis is an autoimmune disease, meaning that the body confuses healthy tissue for foreign substances and attacks itself. The cause is unknown. The disease often begins with fatigue, morning stiffness, weakness, and muscle aches. Eventually, joint pain appears. Pain may affect the wrists, knees, elbows, fingers, toes, ankles or neck.

Other symptoms may include anemia, eye burning, limited range of motion, skin redness and swollen glands. Joint destruction may occur within 1 to 2 years after the disease appears. Some cases cause deformities. Treatment typically begins with medications but may include physical therapy and surgery.

Katrina Donahue, M.D., M.P.H., an assistant professor of family medicine in the UNC School of Medicine and a fellow in the Cecil G. Sheps Center for Health Services Research at UNC, is lead author of the report. She said additional important findings in the report include:

Combining prednisone with the synthetic DMARD hydroxychloroquine, methotrexate or sulfasalazine works better than using only a synthetic DMARD to reduce joint swelling and tenderness and to improve function.

No meaningful clinical differences can be found between methotrexate and either leflunomide or sulfasalazine

Combining the synthetic DMARDs methotrexate and sulfasalazine is no more effective than using just one of the medications for patients with early rheumatoid arthritis.

Not enough evidence exists to determine whether combining two biologic DMARDs is more effective than using one biologic DMARD.

About 17 of every 1,000 people taking a biologic DMARD for 3 to 12 months have a serious infection. Combining two biologic DMARDs can increase the risk.

Among biologic DMARDS, rates of painful injection site reactions are more common for anakinra (67 percent) than for etanercept (22 percent) or adalimumab (18 percent).

More long-term research is needed on rheumatoid arthritis medications, including how the outcomes of these drugs vary among patients with different health conditions and demographic characteristics. More comparative studies on various combinations of drugs are critical. Also important is investigating whether taking the medications earlier (especially biologic DMARDs) is better for long-term outcomes

The report, Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults, was conducted by AHRQ's RTI-UNC Evidence-based Practice Center -- a collaboration between RTI and the five health professions schools and the Cecil G. Sheps Center for Health Services Research at UNC.

Stephanie Crayton | EurekAlert!
Further information:
http://www.unch.unc.edu
http://www.effectivehealthcare.ahrq.gov

More articles from Health and Medicine:

nachricht UIC researchers find unique organ-specific signature profiles for blood vessel cells
18.02.2020 | University of Illinois at Chicago

nachricht Remdesivir prevents MERS coronavirus disease in monkeys
14.02.2020 | NIH/National Institute of Allergy and Infectious Diseases

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: A step towards controlling spin-dependent petahertz electronics by material defects

The operational speed of semiconductors in various electronic and optoelectronic devices is limited to several gigahertz (a billion oscillations per second). This constrains the upper limit of the operational speed of computing. Now researchers from the Max Planck Institute for the Structure and Dynamics of Matter in Hamburg, Germany, and the Indian Institute of Technology in Bombay have explained how these processes can be sped up through the use of light waves and defected solid materials.

Light waves perform several hundred trillion oscillations per second. Hence, it is natural to envision employing light oscillations to drive the electronic...

Im Focus: Freiburg researcher investigate the origins of surface texture

Most natural and artificial surfaces are rough: metals and even glasses that appear smooth to the naked eye can look like jagged mountain ranges under the microscope. There is currently no uniform theory about the origin of this roughness despite it being observed on all scales, from the atomic to the tectonic. Scientists suspect that the rough surface is formed by irreversible plastic deformation that occurs in many processes of mechanical machining of components such as milling.

Prof. Dr. Lars Pastewka from the Simulation group at the Department of Microsystems Engineering at the University of Freiburg and his team have simulated such...

Im Focus: Skyrmions like it hot: Spin structures are controllable even at high temperatures

Investigation of the temperature dependence of the skyrmion Hall effect reveals further insights into possible new data storage devices

The joint research project of Johannes Gutenberg University Mainz (JGU) and the Massachusetts Institute of Technology (MIT) that had previously demonstrated...

Im Focus: Making the internet more energy efficient through systemic optimization

Researchers at Chalmers University of Technology, Sweden, recently completed a 5-year research project looking at how to make fibre optic communications systems more energy efficient. Among their proposals are smart, error-correcting data chip circuits, which they refined to be 10 times less energy consumptive. The project has yielded several scientific articles, in publications including Nature Communications.

Streaming films and music, scrolling through social media, and using cloud-based storage services are everyday activities now.

Im Focus: New synthesis methods enhance 3D chemical space for drug discovery

After helping develop a new approach for organic synthesis -- carbon-hydrogen functionalization -- scientists at Emory University are now showing how this approach may apply to drug discovery. Nature Catalysis published their most recent work -- a streamlined process for making a three-dimensional scaffold of keen interest to the pharmaceutical industry.

"Our tools open up whole new chemical space for potential drug targets," says Huw Davies, Emory professor of organic chemistry and senior author of the paper.

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

70th Lindau Nobel Laureate Meeting: Around 70 Laureates set to meet with young scientists from approx. 100 countries

12.02.2020 | Event News

11th Advanced Battery Power Conference, March 24-25, 2020 in Münster/Germany

16.01.2020 | Event News

Laser Colloquium Hydrogen LKH2: fast and reliable fuel cell manufacturing

15.01.2020 | Event News

 
Latest News

"Make two out of one" - Division of Artificial Cells

19.02.2020 | Life Sciences

High-Performance Computing Center of the University of Stuttgart Receives new Supercomuter "Hawk"

19.02.2020 | Information Technology

A step towards controlling spin-dependent petahertz electronics by material defects

19.02.2020 | Power and Electrical Engineering

VideoLinks
Science & Research
Overview of more VideoLinks >>>