TNF-a blockers an advance but should be reserved for
severe RA
Tumour necrosis factor-alpha (TNF-a) blockers should
be reserved for patients with severe, highly active rheumatoid arthritis
that is unresponsive to at least two other disease modifying drugs, including
methotrexate, according to the Drug and Therapeutics Bulletin.
A review of the TNF-a blockers etanercept (Enbrel)
and infliximab (Remicade) in the July issue of the bulletin (2001;39:49)
says that both drugs appear to be an advance in the treatment of rheumatoid
arthritis (RA). Both reduce symptoms of active disease within two weeks
of starting treatment, although symptoms can recur within a few weeks
of stopping.
The bulletin states that etanercept and infliximab
can slow the progression of joint damage but that there is much to learn
about their role in early disease, their effects on disease progression,
their long-term efficacy and their effects on the immune system.
The bulletin recommends that treatment with etanercept
and infliximab should be started and supervised by a hospital rheumatologist.
The Academic Research Council Epidemiology Research
Unit at the University of Manchester now has a registry that will monitor
the use, benefits and toxicity of TNF-a blockers. The British Paediatric
Rheumatology Group is developing a similar registry for children, the
bulletin says.
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