Sometimes Three Rheumatoid Arthritis Pills Work Best

Combing rituximab, methotrexate, and TNF inhibitor improved RA pain management

(RxWiki News) Many of the current treatments for rheumatoid arthritis have serious side effects. Recently, researchers tested a new drug combination to see if a one-two-three punch could reduce rheumatoid arthritis's painful symptoms.

The researchers tested a drug combination consisting of rituximab (Rituxin®), methotrexate, and TNF inhibitor (the main type of drug used to treat rheumatoid arthritis). They found the drug combination was mildly safer than TNF inhibitor treatment alone, and improved patients' pain symptoms.

dailyRx Insight: Combing three drugs improved the symptoms of rheumatoid arthritis by 30 percent.

For the clinical trial, the researchers had patients with rheumatoid arthritis take either the three drug combination or a similar combination that replaced rituximab with placebo. Patients in the placebo group were slightly more likely to get an infection than those in the rituximab group. One patient in the rituximab group contracted pneumonia while another developed coronary artery disease. However, because so few patients participated in the study, the authors could not make definitive conclusions.

According to the ACR20 measure (a standard used by the American College of Rheumatology), patients in the rituximab group showed a 30 percent improvement by the end of the 24-week study, compared to a 17 percent improvement in the placebo group.

There are approximately 1.3 million rheumatoid arthritis sufferers in the United States, about 75 percent of whom are women. Rheumatoid arthritis damages the joints, most commonly in the hands, feet, and cervical spine. Inflammation can also affects other organs and systems in the body such as the skin, lungs (fibrosis), kidneys (amyloid protein deposits), and cardiovascular system (increased risk for heart attack and stroke, as well as fibrosis and pericarditis). A clinical diagnosis can be made on the basis of symptoms, physical exam, radiographs, x-rays and lab tests. There are many prescription medications used to treat rheumatoid arthritis such as hydroxychloroquine (Plaquenil®), chloroquine (Aralen®), leflunomide (Arava®), and methotrexate (Rheumatrex ®). Non-pharmacological treatment includes psychical therapy, orthoses, and nutritional therapy but these do not stop progression of joint destruction. Analgesia (painkillers) and anti-inflammatory drugs, including steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are required to inhibit or halt the underlying immune process and prevent long-term damage. Recently the newer group of biologics, such as abatacept (Orencia®), adalimumab (Humira®), etanercept (Enbrel®), infliximab (Remicade®), and rituximab (Rituxan®) have increased treatment options.

The study is published in Arthritis & Rheumatism.