Counseling Points - November 2008 - (Page 11)

life (HRQOL) benefits in patients with RA assigned to TNF inhibitors. 1 7 Treatment with infliximab plus methotrexate over 24 months or placebo plus methotrexate in the Anti-TNF Trial in Rheumatoid Arthritis with Concomitant Therapy (ATTRACT) trial resulted in significant improvements in HAQ-DI (overall median improvement in infliximab groups 0.4 versus 0.1 in the placebo group; P<0.006).17 Additionally, treatment with etanercept in a phase-3, randomized, controlled trial demonstrated improvements in physical function based on HAQ-DI scores as early as 2 weeks after initiation. As beneficial as TNF antagonist treatment has been for many patients, approximately 30% of RA patients fail to respond adequately or experience intolerable adverse effects with these drugs. Often times if patients do not respond to one TNF inhibitor, they may have a better outcome switching to another TNF blocking agent. 18 Why a proportion of patients respond to one TNF antagonist over another is unclear; however, failure to achieve universal response raises questions on exactly how pivotal TNF is in the RA disease process.18 action.19 It improves symptoms of RA by selectively blocking the costimulatory signal imparted by proteins CD80 and CD86, which is necessary for full T-cell activation.19 The agent is recommended for use in patients for whom methotrexate in combination with DMARDs has led to an inadequate response and for those with at least moderate disease activity and features of poor prognosis. 12 Numerous controlled clinical trials have established the efficacy of abatacept in RA. For example, results from the Abatacept in Inadequate responders to Methotrexate (AIM) trial demonstrated that the agent sustained inhibition of radiographic progression over 2 years in RA patients who previously had had an inadequate response to methotrexate.20 At 1 year, significantly more patients in the abatacept group achieved ACR 20, ACR 50, and ACR 70 responses (73.1%, 48.3%, and 28.8%, respectively) than in the placebo group (39.7%,18.2% and 6.1% respectively, P 1 agent prior to anti-TNF therapy), and had active disease defined as at least eight 11 NOVEMBER 2008 TNF-Antagonist Alternatives As beneficial as TNF antagonist treatment has been for many patients, approximately 30% of RA patients fail to respond adequately or experience intolerable adverse effects with these drugs.11 This may be due to the important differences between patients with RA that have been demonstrated both in their genetics and in various patterns of molecules involved in inflamed tissues of affected joints.11 Thus, biologic DMARDs that target different mechanisms and cytokines other than TNF have been developed. These agents attack specific inflammatory cytokines, modulate T cells, or target B cells that express particular proteins involved in the RA disease process.11 Abatacept Abatacept, a T-cell costimulatory blocker, is a recombinant fusion protein that has a unique mechanism of

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Counseling Points - November 2008 Welcome Quality of Life and Treatment Options in Rheumatoid Arthritis Counseling Points

Counseling Points - November 2008

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