Good news about rituximab safety in RA; what to try before launching biologicals; what's the best long-term treatment; a head-to-head study of biologics, and more ...
The following are highlights of presentations about treatment of rheumatoid arthritis at the American College of Rheumatology 2012 annual meeting in Washington DC. (Click on abstract numbers below to see the full abstract of the presentation.)
• Rituximab proves safe on long-term treatment. An international study involving 3595 patients treated with rituximab and observed for a decade showed (1) mild or moderate infusion reactions the most common adverse event, (2) serious infections no more common than among placebo group, (3) no increased malignancy rates, and (4) MI rates no higher than among other groups of RA patients. (Abstract #459)
• Abatacept and adalimumab give comparable results. The first head-to-head study comparing biologic agents in RA patients on methotrexate found these two drugs comparable by most measures including radiographic progression, as well as similar in adverse events (which were mild). These were one-year data from a randomized phase IIIb trial of 646 patients. (Abstract #2449)
• DMARDs before biologicals is an effective strategy. A multinational double-blind trial of 353 patients with active disease despite methotrexate therapy compared triple therapy involving DMARDs (methotrexate, sulfasalzine and hydroxychloroquine) to methotrexate plus etanercept. Response rates, toxicities, radiographic progression, and quality-of-life measures were not different across groups. (Abstract #1287)
• Are older RA patients getting substandard treatment? A poster offered by Swedish researchers found that patients who develop RA when they're older than 58 are more likely to receive corticosteroids rather than DMARDs, biologics, or methotrexate, despite the health risks and lower efficacy of the former. (Abstract #2145)
• Continuing etanercept in stable patients preferable to discontinuation. In a late-breaking abstract, Ronald van Vollenhoven, MD, of the Karolinska Institute in Stockholm reported on a 73-patient randomized trial of continuing 50 mg of etanercept weekly compared to placebo. Patients were aged 18 or older, stable on methotrexate, with no prior history of anti-TNF therapy or etanercept discontinuation. Patients remaining on the drug were significantly more likely to remain stable 48 weeks after randomization. This abstract is not available but a longer report is on MedPage Today.
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