Arthritis Arthritis Treatment

Rheumatoid Arthritis: TNF-Alpha Blockers

Remicade® (infliximab) also reduces inflammation in patients with rheumatoid arthritis by blocking the TNF-alpha molecule. It is a monoclonal antibody derived from human and mouse genes. It was approved by the U.S. Food and Drug Administration in 1999.

Remicade is given by intravenous infusion in the doctor's office or hospital. Each infusion takes about 2 hours. The intravenous treatments are given three times during the first six weeks of therapy and after that, every eight weeks. It is typically given alone or in combination with other DMARDs, like methotrexate, to increase the therapeutic benefits and limit the side effects.

Like Enbrel, treatments with Remicade may weaken the body's ability to fight infection. Patients are encouraged to see their doctor if signs of infection such as fever, sweats, chills, skin rash or other symptoms are present.

Research conducted since the U.S. Food and Drug Administration’s approval shows there may be a link between Remicade and an increased risk of cancer or lymphoma. However, since patients with rheumatoid arthritis have a higher risk of lymphoma than the general population, this link has not been confirmed. Patients with congestive heart failure should not use Remicade.

Humira® (adalimumab), the newest TNF-alpha blocker, was approved for the treatment of rheumatoid arthritis in 2002. Like Enbrel, it is a synthetic, man-made protein that slows the progressive destruction of the joints and improves physical function in moderate to severe cases of rheumatoid arthritis. It is a self-administered injection taken once every two weeks and can also be used alone or in combination with other medications.

Doctors have reported rare cases of severe allergic reactions including difficulty with breathing, hives and itching. A weak or rapid pulse and blood cell deficiencies have also occurred. Bruising or bleeding can be a sign of blood cell problems and should be reported to a physician.

Serious infections have been seen in clinical trials when Humira was taken with another rheumatoid arthritis drug named Kineret® (anakinra). It has also been associated with serious infections such as tuberculosis, sepsis and fungal infections. Humira may worsen the symptoms of central nervous system diseases like multiple sclerosis.

Regular Monitoring Is Important
Because biologic medications suppress the immune system, they can make patients more susceptible to other infections and diseases. In fact, the most significant side effect of these medications is an increased risk of all types of infections, including tuberculosis. That is why doctors will administer a tuberculosis test before starting a patient on a TNF-alpha blocker. For the same reason, these medications should be stopped when an active infection is present, or if an antibiotic is required. Similarly, patients should seek immediate medical attention if they develop a persistent fever.

Biologics may cause certain chronic diseases in remission to flare up, and they are often not recommended for people with multiple sclerosis and other conditions. A link has also been suggested between some biologics and cancer. However, since patients with rheumatoid arthritis have a higher rate of cancers than the general population, the connection between cancer remains unclear and under investigation.

Much about these drugs remains under investigation, since they have only been in use for only a few years. Their long-term effects remain unknown, and continue to be reviewed. Regular monitoring by a physician, including periodic blood tests and other tests, may be needed to determine the effectiveness of the treatment and the presence of any side effects.

Biologics Are Not for Everyone
Finally, it is important to remember that biologic medicines are not for everyone. How well they work varies from person to person. In some people, they may not work at all. For others, one biologic may not work but another may be effective. Biologics are also much more expensive than what are considered to be conventional treatments for rheumatoid arthritis. Treatment can cost at least $10,000 and often more per year. Their cost and the lack of insurance reimbursement may limit their availability for some patients.

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