A new study reveals promising findings of an emerging modality for treating rheumatoid arthritis. The study, which was recently published in The New England Journal Of Medicine, found the use of abatacept resulted in significant clinical improvement and improved physical function when researchers administered the medication to patients who had previously tried and failed to get an adequate response from anti-TNF-a therapy for active rheumatoid arthritis (RA).

A recent study shows promising findings for abatacept in treating active rheumatoid arthritis.

       After six months, over 50 percent of those in the abatacept group had American College of Rheumatology (ACR) 20 responses compared to 19.5 percent of those in the placebo group, according to the randomized, double-blind study. Approximately 20 percent of those in the abatacept group had ACR 50 responses compared to only 3.8 percent in the placebo group.
       Mark C. Genovese, MD, the lead author of the study, believes these findings are promising for clinicians and patients looking for another treatment alternative for RA.
       “I believe it will have a significant impact, particularly for those patients who have had an inadequate response to TNF-a inhibitors such as etanercept, infliximab or adalimumab,” notes Dr. Genovese, an Associate Professor of Medicine in the Division of Immunology and Rheumatology at the Stanford University School of Medicine.
       Dr. Genovese says abatacept offers unique benefits in the treatment of this condition.
       “Abatacept is an entirely different class of medication,” explains Dr. Genovese. “As a selective costimulation modulator, it interferes with a signaling process between certain cell types in the immune system. As such, it can block initiation and stimulation of T cells, and downregulate activated T cells, which are important in the initiation and perpetuation of rheumatoid arthritis.”
       In order to be eligible for the study, patients had to have been at least 18 years old, had to have rheumatoid arthritis for at least a year and had an inadequate response to at least three months of anti-TNF-a therapy.
       At the Stanford University Medical Center, Dr. Genovese notes that they see a lot of patients on referral or via consultation for refractory RA. With the study, he says he was “pleasantly surprised” to see how effective abatacept was in treating patients with otherwise very refractory disease.

Addressing Obesity And Arthritis In Baby Boomers
       In regard to obesity and arthritis among the baby boomer population, some alarming statistical trends have emerged from a study, which was recently published in the American Journal Of Public Health.
       Analyzing data from the U.S. Census Bureau and the National Center of Health Statistics, the researchers found that the percentage of arthritis cases directly linked to obesity increased from 3 percent in 1971 to 18 percent in 2002. In regard to whether obese people are more likely to develop arthritis than those who are not overweight, the percentage jumped from 20 percent in 1971 to 60 percent in 2002.
       Deborah Brown, APRN, BC, says the study suggests that obesity is a contributing factor in the rise of degenerative joint disease (DJD) in recent years. An orthopaedic nurse practitioner, Brown sees a “fair amount” of obese baby boomers at the Beth Israel Deaconess Medical Center in Boston. She says these patients commonly have parents who have had one or more joints replaced and want to prevent it from happening to them.
       Brown advocates developing a comfort level with the patient where one can discuss and emphasize the importance of weight loss. In order to facilitate the best results, she strongly encourages a team approach that involves the patient, a significant other, the patient’s primary care provider, a physical therapist and a nutritionist.

Adalimumab Gains New FDA Approvals For PsA and RA
       Based on the results of two key clinical studies, adalimumab (Humira, Abbott) has garnered approval from the Food and Drug Administration (FDA) for two new indications. It has been approved for treating the signs and symptoms of active arthritis in patients with psoriatic arthritis, and as a first-line treatment for the recent onset of moderate to severe RA.

These bilateral hand X-rays are consistent with psoriatic arthritis (PsA). Adalimumab recently garnered FDA approval for treating the signs and symptoms of PsA.

       “The formal FDA approval for TNF-a inhibitors as a first-line therapy for RA is significant in that it will encourage the use of these drugs at earlier disease stages,” offers Brian Peck, MD, an Assistant Clinical Professor of Medicine at the Yale University School of Medicine.
       “Some rheumatologists are already using these drugs at earlier stages but many await formal FDA approval before changing practice standards with any drug.”
       The expanded indication of adalimumab for RA was based upon a two-year study of nearly 800 patients with active recent onset of moderate to severe RA. Sixty-two percent of the patients on the combination regimen of methotrexate and adalimumab had ACR 50 responses compared to 46 percent of those on methotrexate alone and 41 percent of those on adalimumab alone.
       Dr. Peck says early, aggressive treatment of RA is essential as it “increases the chances of delaying or avoiding joint destruction and of maintaining function.” While there have been several revolutions in RA treatment over the years, Dr. Peck says adalimumab’s expanded indication for the first-line treatment of RA is another significant advance.
       “Formal FDA approval of one of the methods of achieving early, aggressive therapy represents another milestone in the overall evolution of RA therapy,” emphasizes Dr. Peck.
Key Insights On Adalimumab For Psoriatic Arthritis
       Adalimumab’s indication for psoriatic arthritis (PsA) was based on the ADEPT trial, a study of over 300 patients with moderate to severe PsA who had failed to respond to NSAID treatment for the condition.
       After seeing the promising preliminary data on the medication, Nathan Wei, a Fellow of the American College of Rheumatology, has been using adalimumab off-label to treat PsA. He says his experience with adalimumab has been “overwhelmingly positive.”
       “The skin response is the most dramatic change in these patients,” offers Dr. Wei, who is in private practice at the Arthritis and Osteoporosis Center of Maryland in Frederick, Md. “Many patients with PsA ostracize themselves because of their skin disease. They are reluctant to socialize and often develop secondary depression. You can imagine what happens when their skin disease improves. Their self image improves dramatically as well.”
       Dr. Wei says the effectiveness of a medication like adalimumab for PsA should not be a surprise.
“The reason for the skin response is that psoriatic skin lesions are abundant in T cell and cytokine (specifically TNF) content,” explains Dr. Wei. “It makes sense that an anti-TNF drug would work so well.”