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New study compares two drugs combined with methotrexate for rheumatoid arthritis treatment

Robin Wulffson MD's picture
rheumatoid arthritis, abatacept, Orencia, Aaalimumab, Humira, methotrexate

Research is ongoing for effective treatment of the debilitating condition of rheumatoid arthritis. With the approval of a new product, rheumatoid arthritis sufferers hold out the hope that it will be effective for them. Even after release, the pharmaceuticals are the subject of ongoing evaluation. A new study was conducted to compare the efficacy of abatacept to adalimumab both with background methotrexate. Researchers affiliated with Brigham and Women's Hospital, Boston, Massachusetts published their findings online on November 20 in the journal Arthritis and rheumatism.

The researchers noted that a need exists for comparative studies to provide evidence-based treatment guidance for biologics in rheumatoid. Therefore, the designed the first head-to-head study in rheumatoid arthritis, which compared subcutaneous abatacept versus adalimumab both with background methotrexate. The primary end point was the ACR20 response at one year. The ACR score is a scale to measure change in rheumatoid arthritis symptoms. It is named after the American College of Rheumatology.

Patients with active rheumatoid arthritis who had not received biologic therapy and had exhibited an inadequate response to methotrexate were randomly assigned to 125 mg subcutaneous abatacept weekly or 40 mg subcutaneous adalimumab bi-weekly, both in combination with methotrexate in a two-year study.

The study group comprised 646 patients were randomized to receive either abatacept or adalimumab plus methotrexate; 86.2% of the patients who received abatacept and 82% of the patients who received adalimumab completed 12 months of therapy. At one year, 64.8% and 63.4% of patients, respectively, demonstrated an ACR20 response; the estimated difference between groups was 1.8, which demonstrated the non-inferiority of abatacept versus adalimumab. The investigators noted that all efficacy measures showed similar results and kinetics of response. Rates of radiographic (X-ray) non-progression were 84.8% and 88.6%. The incidence of serious adverse events was 10.1% and 9.1%; serious infections were 2.2% and 2.7%. Discontinuations due to adverse events were 3.1% versus 6.1%, due to serious adverse events were 1.3% versus 3%. Injection site reactions occurred in 3.8% versus 9.1%.

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The authors concluded that “abatacept demonstrated comparable efficacy versus adalimumab with similar kinetics of response and inhibition of radiographic progression at 1 year. The safety was generally similar other than significantly more local injection site reactions with adalimumab.”

Abatacept (Orencia; Bristol Myers Squibb) reduces the pain, swelling, difficulty with daily activities, and joint damage caused by rheumatoid arthritis in patients who have not been helped by other medications. Abatacept is in a class of medications called selective costimulation modulators (immunomodulators). It works by blocking the activity of T-cells, a type of immune cell in the body that causes swelling and joint damage in people who have arthritis.

Adalimumab (Humira; Abbott) is recommended for moderate to severe rheumatoid arthritis in adults. Humira can be used alone, with methotrexate, or with certain other medicines. Humira may prevent further damage to bones and joints and may help one’s ability to perform daily activities. It is the third tumor necrosis factor (TNF) inhibitor, after infliximab and etanercept, to be approved in the United States.

Reference: Arthritis and Rheumatism

See also: Xeljanz may help rheumatoid sufferers not helped by methotrexate



For the Consumer Applies to adalimumab: subcutaneous kit Get emergency medical help if you have any of these signs of an allergic reaction while taking adalimumab (the active ingredient contained in Humira) hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using adalimumab and call your doctor right away if you have any of these symptoms of lymphoma: fever, night sweats, weight loss, tiredness; feeling full after eating only a small amount; pain in your upper stomach that may spread to your shoulder; easy bruising or bleeding, pale skin, feeling light-headed, rapid heart rate; or liver problems--nausea, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Stop using adalimumab and call your doctor at once if you have any of these other serious side effects: signs of infection (fever, chills, sore throat, vomiting, diarrhea, flu symptoms); shortness of breath with swelling of your ankles or feet; confusion, neck stiffness, seizure (convulsions); pain or burning when you urinate; sudden numbness or weakness, sudden severe headache, problems with vision or balance; chest pain, sudden or ongoing cough, wheezing, rapid breathing, coughing up mucus or blood; tingly feeling, weakness or prickly feeling in your fingers or toes; problems with balance or eye movement, trouble speaking or swallowing; severe lower back pain, loss of bladder or bowel control; pain, swelling, warmth, or redness in one or both legs; red, purple, or scaly skin rash, hair loss, muscle pain, mouth sores; joint pain or swelling, swollen glands, muscle aches, unusual thoughts or behavior; or patchy skin color, red spots, or a butterfly-shaped skin rash over your cheeks and nose (worsens in sunlight). Less serious side effects of adalimumab may include: headache; stuffy nose, sinus pain; mild stomach pain; or pain, redness, itching, swelling, or bleeding where you injected the medication. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.
The above comments are informative and much appreciated.
As RA is an auto immune disease, we need to find causes, rather than 'treat' symptoms with dangerous chemicals. That is not scientific. It isn't even pseudo science! Omega 3 is beneficial to the immune system. So is Zinc, Vitamin C, Vitamin A, and all the other vitamins. But, If the immunity is low, would it not be more beneficial to find the cause of that depletion? The indoctrination of the medical system, relying on the drug cartels is the cause of this 'pill popping' syndrome! A pill for every ill! Or a vitamin for every ill! Any food item that is alien to the human system causes it to react by activating the immune system. The digestive system only gets activated when the brain 'recognizes a 'food' as beneficial. The vagus nerve does that. In regards to the function of the vagus nerve, its purpose is to innervate the organs of the body. Specifically, the function of the vagus nerve is to relay signals from the taste buds in the mouth to the brain and (if an item is recognized as beneficial) from there to the various body systems to regulate heart rate, speech, sweating, blood pressure, digestion, glucose production, and certain aspects of breathing. Not only is the nerve responsible for innervating organs, but it also controls certain skeletal muscles, such as the larynx. It is either finding out what you are allergic to, or spending enormous amounts of non effective medication or supplements. Most people are allergic to the following items; dairy, the most allergenic substance, and best totally avoided, peanuts, particularly in young children, eggs, potato, onion, food colouring, food flavouring, Tobacco, M.S.G, Medicine (side effects), L.S.D, Marijuana, alcohol and other mind altering substances, chlorine (in young children in particular), and fluoride. (Don't be misled by the 'raw milk is non allergenic' reports you often read! It is incorrect and it could cost you your life).