Celecoxib for JRA under surveillance.: An article from: Family Practice News
Product DescriptionThis digital document is an article from Family Practice News, published by Thomson Gale on January 15, 2007. The length of the article is 545 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon. com Digital Locker immediately after purchase. You can view it with any web browser. Citation DetailsTitle: Celecoxib for JRA under surveillance. (News)(drug approvals for juvenile rheumatoid arthritis)Author: Elizabeth MechcatiePublication: Family Practice News (Magazine/Journal)Date: January 15, 2007Publisher: Thomson GaleVolume: 37 Issue: 2 Page: 7(1)Distributed by Thomson Gale
Celecoxib for JRA under surveillance.: An article from: Family Practice News
The best For DMARD-resistant rheumatoid arthritis patient.
The best For DMARD-resistant rheumatoid arthritis patient.
From Rituximab use in everyday clinical practice as a first-line biologic therapy for the treatment of DMARD-resistant rheumatoid arthritis
D. McGonagle1,2, A. L. Tan2, J. Madden1, L. Taylor1 and P. Emery2
1Department of Rheumatology, Calderdale Royal Hospital, Salterhebble, Halifax and 2Academic Unit of Musculoskeletal Disease, University of Leeds and Chapel Allerton Hospital, Leeds, UK.
RA is the commonest inflammatory arthropathy and affects nearly half a million patients in the UK. The current first-line treatment utilizes DMARDs that often have suboptimal responses . The introduction of TNF inhibitors offered a new option for patients with DMARD-resistant disease . Upon the licensing of anti-TNF agents, the health care service structure of the UK meant that literally hundreds of thousands of patients were potentially suitable for therapy. Given the costs of therapy, the prescribing of anti-TNF agents for inflammatory arthritis has been patchy, which has restricted the availability of anti-TNF agents in some regions .Rituximab in combination with MTX was licensed in the UK in 2006 for the treatment of adult patients with severe active RA who have had an inadequate response to, or been intolerant to conventional DMARDs and one or more TNF inhibitors. However, the early clinical studies that demonstrated the efficacy of rituximab in RA were carried out in patients who had not previously received TNF inhibitors . Recognizing that rituximab was going to be licensed for RA and due to the inability to obtain anti-TNF therapy, we have used rituximab as a first-line biological agent between 2004 and early 2007. In this article, we report our experience for the treatment of RA in daily clinical practice in a non-academic centre.
This study reports the use of rituximab for RA in a ‘real world’ non-academic environment in patients, the vast majority of whom had not previously received anti-TNF therapy. A recent report showed the efficacy of rituximab in RA in a similar situation , but the patients in question had failed anti-TNF therapy, whilst our report focused mainly on patients who failed DMARDs only. Almost half the cases had disease where some rheumatologists would have concerns about using anti-TNF agents including risks of infection and strong ANA positivity. We found that rituximab was extremely well tolerated. Based on the experience in haematology and oncology it would appear that the short-term safety data of rituximab is at least as good as the anti-TNF agents [14]. For example, there is no apparent increased risk of serious infections including tuberculosis. Concerns have also been raised that the anti-TNF agents may be associated with an increased long-term risk of lymphoreticular malignancies including lymphomas, some of which rituximab is licensed to treat . In the case of malignancy, rituximab has been predominantly used as a single course of therapy.
Conclusions. Rituximab is well tolerated in everyday clinical practice and may represent a good short-term treatment option where anti-TNF therapy is either unavailable or relatively contraindicated.
