вторник, 31 мая 2011 г.

Animal Model Of Rheumatoid Arthritis (KRN-CTM) Deepens Understanding Of The Disease

Current research provides a novel model for rheumatoid arthritis research. The related report by LaBranche et al, "Characterization of the KRN cell transfer model of rheumatoid arthritis (KRN-CTM), a chronic yet synchronized version of the K/BxN mouse," appears in the September 2010 issue of The American Journal of Pathology.



Nearly 1% of the population is affected by rheumatoid arthritis, and women are affected three to five times more often then men. Although the course of disease varies greatly, daily living activities are impaired in most affected individuals and after 5 years approximately 33% of sufferers are no longer able to work.



Rheumatoid arthritis is characterized by chronic inflammation of the distal joints and is mediated in part by emigration and activation of immune cells. The restrictions of present animal models, which either mimic chronic disease or a synchronized version of early disease (but not both), have hampered scientific understanding of the specific roles immune cells and their mediators play in disease initiation and maintenance. In this regard, Dr. Paul Allen and colleagues at the Washington University in St. Louis School of Medicine, in collaboration with Dr. Timothy LaBranche and colleagues at Pfizer Global Research & Development developed and characterized a chronic yet synchronized animal model of rheumatoid arthritis (KRN-CTM). Disease in these animals developed with a uniform onset of 7 days post-initiation and was maintained chronically (through Day 42). These mice revealed a time course of rheumatoid arthritis characteristics including edema, immune cell infiltration, cartilage damage and osteoclast-mediated bone resorption.



According to Dr. LaBranche, "the main benefit of the KRN-CTM is its utility, which adds significant logistical and platform advantages to study T cell targets since the model is T cell-dependent and engages both early and late stages of innate and adaptive immune responses (a drawback of the antibody-dependent K/BxN serum transfer model). In addition, by polarizing T helper (Th) cells and/or knocking down genes prior to transfer, the KRN-CTM may enable investigators to ask how specific Th subsets and/or specific T cell genes contribute to disease. Lastly, incidence, onset, and severity of disease are highly synchronized without requiring adjuvant. The KRN-CTM presents a novel opportunity for investigators to study specific pathways and mechanisms involved in both the early and chronic phases of disease, thereby enabling the validation of targets and biopharmaceuticals for rheumatoid arthritis patients."



In future studies Dr.'s Allen and LaBranche aim to demonstrate the utility of the KRN-CTM, illustrating the roles Th subsets and particular genes have in both the model and people.

понедельник, 30 мая 2011 г.

Level Of Osteoarthritis Pain May Determine Efficacy Of Glucosamine, Chondroitin Sulfate

The popular dietary supplements glucosamine and chondroitin sulfate proved no better than a placebo in relieving osteoarthritis knee pain in most participants of a major national trial. But the study, published in the Feb. 23 issue of the New England Journal of Medicine, also showed a smaller subgroup of trial patients with moderate to severe osteoarthritis knee pain taking the combination of the two supplements experienced significant pain relief.



"For the study population as a whole, supplements were found to be ineffective," said rheumatologist Daniel O. Clegg, M.D., professor of medicine at the University of Utah School of Medicine, chief of rheumatology at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, and principal investigator for the national trial. "An exploratory analysis suggested, however, that the combination of glucosamine and chondroitin sulfate might be effective in patients who suffer from moderate to severe osteoarthritis knee pain."



Glucosamine, an amino sugar the body produces and distributes in cartilage and other connective tissue, and chondroitin sulfate, a complex carbohydrate that helps cartilage retain water, have become popular remedies among osteoarthritis sufferers in recent decades. But evidence of the supplements' ability to control pain had been anecdotal.



The five-year, $12.5 million Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) was designed to rigorously assess the efficacy and safety of glucosamine and chondroitin sulfate, taken either separately or in combination. Nearly 1,600 patients with painful knee osteoarthritis were enrolled in the trial and randomly assigned to take placebo, celecoxib (a widely prescribed arthritis pain drug), glucosamine, chondroitin sulfate, or a combination of the two supplements for 24 weeks. Of the 1,583 study patients, 78 percent were in the mild knee pain subgroup and the remaining 22 percent were in the moderate to severe subgroup.



Celecoxib served as the study's positive control because it is an approved osteoarthritis pain drug and participants would be expected to respond in a predictable way.



For all trial patients, celecoxib proved most effective in providing significant pain relief, with a 70 percent response rate, compared to 64 percent for glucosamine and 65 percent for chondroitin sulfate. Taken in combination, the supplements provided significant relief for 66 percent of patients who receive them. The response rate in those who took placebo was 60 percent.



In participants in the mild knee pain subgroup, celecoxib proved the most effective, significantly improving pain relief for 70 percent of those who took it, compared to nearly 64 percent for glucosamine, 67 percent for chondroitin sulfate, and 63 percent for the combination of the two. Placebo produced a 62 percent response rate for people with mild pain.
















"As we expected, patients who took celecoxib showed significant improvement in pain relief," Clegg said.



In patients in the moderate-to-severe knee pain subgroup, however, the combination of the two supplements appeared to be more effective than placebo, significantly reducing pain in 79 percent of those who received it. This is compared with 69 percent who took celecoxib and 54 percent who took placebo. Because only 22 percent of the trial participants were in the moderate-to-severe subgroup, this result should be considered preliminary and further study will be required to confirm these results, according to Clegg.



Conducted at 16 U.S. academic rheumatology centers, the study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), components of the National Institutes of Health.



Study participants were required to have both pain and X-ray evidence of osteoarthritis in their knees. They were evaluated at the beginning of the trial and at weeks four, eight, 16, and 24, with a positive treatment response defined as a 20 percent or greater decrease in knee pain compared to the start of the study.



More than 20 million Americans have osteoarthritis. Oral doses of glucosamine and chondroitin sulfate, derived from animal products, have become popular with arthritis sufferers in the past 20 or so years.



"I urge people with osteoarthritis to follow a comprehensive plan for managing their arthritis pain. Developing and maintaining a healthy lifestyle is key to the successful management of osteoarthritis--eat right, exercise regularly, lose excess weight, and consider the use of medications based on your degree of pain," Clegg said.



In a second part of the study, Clegg and other researchers will track whether taking glucosamine and chondroitin sulfate alone and in combination affects progression of knee osteoarthritis. All participants in the second part of the study had a knee X-ray at the beginning of the trial and will be imaged again at years one and two. X-rays will be compared and evaluated to assess whether these supplements affect progression of osteoarthritis. Results of the second part of the study are expected in about a year.







Contact: Phil Sahm

Phil.Sahmhsc.utah

University of Utah Health Sciences Center

Zimmer Holdings And ISTO Technologies Announce Start Of Neocartilage Clinical Trial

Zimmer
Holdings, Inc. (NYSE: ZMH; SWX: ZMH), a leader in the orthopaedics
industry, and ISTO Technologies, Inc., an innovative orthobiologic company,
today announced that the clinical trial is now underway for Neocartilage, a
living tissue-engineered graft under investigation for the restoration of
cartilage defects, reestablishment of joint function and relief of pain in
the knee. Zimmer plans to market the product as DeNovo(R) ET Engineered
Tissue Graft.


In June 2006, the U.S. Food and Drug Administration (FDA) approved
ISTO's Investigational New Drug (IND) application, allowing the companies
to move forward with human clinical trials of the novel cartilage
regeneration treatment.



Jack Farr II, M.D., an orthopaedic surgeon with OrthoIndy,
Indianapolis, performed the surgery on the first patient in November 2006.
"I have participated in a variety of projects involving cartilage repair
and regeneration, and I find the science behind DeNovo ET very compelling,"
said Dr. Farr. "The initial surgery went as we had hoped, and we look
forward to enrolling more patients into the study and serially assessing
their progress with the implant."



Kevin F. Bonner, M.D., an orthopaedic surgeon with Jordan-Young
Institute in Virginia Beach, Virginia, has also enrolled patients into the
study. "In pre-clinical studies, DeNovo ET has demonstrated the ability to
resurface cartilage defects," said Dr. Bonner. "The procedure is
straightforward and builds on earlier cartilage repair techniques."



Additional study sites for the clinical trial are being added.
Recently, Rush University Medical Center in Chicago was added; Dr. Brian
Cole, the head of Rush's Cartilage Restoration Center, will serve as the
principal investigator for the Rush location.



Zimmer and ISTO entered into a co-development agreement in 2002
granting Zimmer exclusive worldwide commercial distribution rights to the
Neocartilage technology. The two companies have since collaborated on
further development and pre-clinical testing. The potential market for
DeNovo ET is large, as each year in the United States alone approximately
500,000 cartilage lesions are treated in knee joints.



"We are delighted both to advance the Neocartilage technology into
human clinical trials, and to be collaborating with the world's leading
orthopaedic company to achieve this significant milestone," said Mitchell
Seyedin Ph.D., President and Chief Executive Officer of ISTO.



"Zimmer has made biologics the centerpiece of our innovative investment
strategy and we are pleased to have reached this very concrete milestone in
the development of our plans," said Ray Elliott, Chairman, President and
Chief Executive Officer of Zimmer Holdings. "With our investments in other
biologic repair and regeneration technologies, we intend to play a
leadership role in the next generation of treatments to address the needs
of patients with arthritis and other orthopaedic issues."
















DeNovo ET is a living tissue graft grown from juvenile chondrocytes
(cartilage cells) using ISTO's proprietary cell-based platform technology.
Studies have demonstrated that juvenile chondrocytes produce cartilage
significantly better than their adult counterparts. Cartilage works as a
low friction articulating surface to protect joints from wear and tear
experienced during motion. Articular cartilage can be damaged as a result
of injury, or can simply deteriorate over time leading to osteoarthritis.
Cartilage is known to have limited capacity to heal on its own. Most joint
replacements are performed as a result of the effects of osteoarthritis.



Zimmer is also developing another cartilage repair product in
conjunction with ISTO. The DeNovo NT Natural Tissue Graft also consists of
juvenile chondrocytes in the form of minced cartilage tissue. This living
tissue graft is also intended to support the surgical repair of damaged
articular cartilage.



About Zimmer



Founded in 1927 and headquartered in Warsaw, Indiana, Zimmer is the
worldwide #1 pure-play orthopaedic leader in designing, developing,
manufacturing and marketing reconstructive and spinal implants, trauma and
related orthopaedic surgical products. Zimmer has operations in more than
24 countries around the world and sells products in more than 100
countries. Zimmer's 2006 sales were approximately $3.5 billion. The Company
is supported by the efforts of nearly 7,000 employees worldwide.



About ISTO Technologies, Inc.



ISTO Technologies, Inc. is an orthobiologic company focused on
developing differentiated products for sports medicine and spinal therapy.
ISTO's products are intended for repair and regeneration of damaged
cartilage in joints and spinal discs.



Visit Zimmer on the worldwide web at zimmer



Zimmer Safe Harbor Statement



This press release contains forward-looking statements within the safe
harbor provisions of the Private Securities Litigation Reform Act of 1995
based on current expectations, estimates, forecasts and projections about
the orthopaedics industry, management's beliefs and assumptions made by
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forward-looking terms such as "may," "will," "expects," "believes,"
"anticipates," "plans," "estimates," "projects," "assumes," "guides,"
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variations on such terms or comparable terminology. These statements are
not guarantees of future performance and involve risks, uncertainties and
assumptions that could cause actual outcomes and results to differ
materially. These risks and uncertainties include, but are not limited to,
our ability to successfully integrate acquired businesses, the outcome of
the Department of Justice investigations announced in March 2005 and June
2006, price and product competition, rapid technological development,
demographic changes, dependence on new product development, the mix of our
products and services, supply and prices of raw materials and products,
customer demand for our products and services, control of costs and
expenses, our ability to conduct a successful search for a new chief
executive officer and the ability of the new chief executive officer to
gain proficiency in leading our company, our ability to form and implement
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affecting our U.S. and international businesses, including tax obligations
and risks, product liability and intellectual property litigation losses,
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conditions and growth rates and general domestic and international economic
conditions including interest rate and currency exchange rate fluctuations.
For a further list and description of such risks and uncertainties, see our
periodic reports filed with the U.S. Securities and Exchange Commission. We
disclaim any intention or obligation to update or revise any
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events or otherwise, except as may be set forth in our periodic reports.
Readers of this document are cautioned not to place undue reliance on these
forward-looking statements, since, while we believe the assumptions on
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no assurance that these forward-looking statements will prove to be
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statements contained in this document.


Zimmer Holdings, Inc.

zimmer

Actemra Approved In Japan To Treat Patients With Rheumatoid Arthritis

Roche announced that their alliance partner company Chugai has received approval in Japan for the use of its innovative treatment, Actemra (tocilizumab), in patients suffering from rheumatoid arthritis (RA).


Actemra was approved by the Japanese authorities for the indication of rheumatoid arthritis (including prevention of structural damage of joints) and two forms of the disease that affect children, know as juvenile idiopathic arthritis and systemic-onset juvenile idiopathic arthritis.


Japan is the first market worldwide to get access to Actemra for the treatment of RA. The approval is based on compelling data from clinical trials conducted in Japan that showed Actemra was highly effective in controlling the symptoms and progression of this serious disease.


"Today's approval represents a significant milestone for rheumatologists and patients in Japan. The Japanese authorities have recognized that Actemra is a breakthrough drug which addresses an unmet medical need for patients suffering from the debilitating effects of this disease" said William Burns, CEO Roche Pharmaceuticals Division.


Actemra is the first of a new class of drug with a novel mechanism of action that brings new hope to RA patients. It is a humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody, which works by suppressing the activity of IL-6, an important trigger of the inflammatory process. This novel mode of action reduces inflammation of the joints and relieves the systemic effects of RA.


Since 2005, Actemra has been marketed in Japan for the treatment of patients with a rare auto-immume condition known as Castleman's disease. Actemra licence applications have also been filed for treatment of RA in the Unites States and the European Union in 2007, and are currently under review.


Rheumatoid Arthritis - A High Unmet Medical Need


Rheumatoid arthritis is a progressive autoimmune disease characterized by inflammation of the membrane lining in the joints throughout the body. This inflammation causes distortion of the joint and impaired function accompanied by pain, stiffness and swelling and ultimately leading to irreversible joint destruction and disability. In addition, the systemic symptoms of RA include fatigue, anaemia, osteoporosis and may contribute to shortening life expectancy by affecting major organ systems. Sadly after 10 years, less than 50% of patients can continue to work or function normally on a daily basis.















Juvenile idiopathic arthritis is the collective term for diseases with unknown cause associated with symptoms in joints occurring in children aged below sixteen. While clinical findings of pJIA have many similarities to rheumatoid arthritis, sJIA is accompanied by systemic symptoms, mostly remittent fever, and is considered a very severe disease.


About Actemra


Actemra is the result of research collaboration by Chugai and is being co-developed globally with Chugai. Actemra is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody. An extensive clinical development program of five Phase III trials was designed to evaluate clinical findings of Actemra. Four studies are completed and have reported meeting their primary endpoints. A fifth trial, a two-year study called LITHE (TociLIzumab safety and THE prevention of structural joint damage), is currently underway and is expected to report preliminary first-year data in 2008. Actemra is awaiting approval in the United States and Europe. In Japan, Actemra was launched by Chugai in June 2005 as a therapy for Castleman's disease; in April 2008, additional indications for rheumatoid arthritis, juvenile idiopathic arthritis and systemic-onset juvenile idiopathic arthritis were also approved in Japan.


Actemra is generally well tolerated. The overall safety profile of Actemra is consistent across all global clinical studies. The most common, non-serious, adverse events reported are upper respiratory tract infection, nasopharyngitis, headache and hypertension. As with other biological disease modifying anti-rheumatic drugs (DMARDs), serious infections and hypersensitivity reactions including a few cases of anaphylaxis, have been reported in some patients treated with Actemra. Increases in liver transaminases (ALT and AST) were seen in some patients; these increases were generally mild and reversible, with no hepatic injuries or any observed impact on liver function.


About Roche in rheumatoid arthritis


One of the most important drivers for growth at Roche over the next few years is expected to be the company's emerging franchise in autoimmune diseases with rheumatoid arthritis as the first indication. Following the launch of MabThera (rituximab) there are a number of projects in development, potentially allowing Roche to build on further opportunities. MabThera is the first and only selective B-cell therapy for RA, providing a fundamentally different treatment approach by targeting B cells, one of the key players in the pathogenesis of RA. Actemra is Roche's second novel medicine and is a humanised monoclonal antibody to the interleukin-6 (IL-6) receptor, inhibiting the activity of IL-6 , a protein that plays a major role in the RA inflammation process. Additional projects creating a rich pipeline include compounds in Phase I, II and III clinical trials. Notably, ocrelizumab, a humanised anti-CD20 antibody, has entered phase III development for RA.


About Roche


Headquartered in Basel, Switzerland, Roche is one of the world's leading research-focused healthcare groups in the fields of pharmaceuticals and diagnostics. As the world's biggest biotech company and an innovator of products and services for the early detection, prevention, diagnosis and treatment of diseases, the Group contributes on a broad range of fronts to improving people's health and quality of life. Roche is the world leader in in-vitro diagnostics and drugs for cancer and transplantation, and is a market leader in virology. It is also active in other major therapeutic areas such as autoimmune diseases, inflammatory and metabolic disorders and diseases of the central nervous system. In 2007 sales by the Pharmaceuticals Division totalled 36.8 billion Swiss francs, and the Diagnostics Division posted sales of 9.3 billion francs. Roche has R&D agreements and strategic alliances with numerous partners, including majority ownership interests in Genentech and Chugai, and invested over 8 billion Swiss francs in R&D in 2007. Worldwide, the Group employs about 79,000 people. Additional information is available on the Internet at roche.


All trademarks used or mentioned in this release are protected by law.


Further information


- Roche & Autoimmune diseases

- Chugai


roche


View drug information on Actemra.

NEXIUM(R) Shown To Reduce Gastric Ulcers In At-Risk Patients Using Long-Term NSAIDs

Results from two
clinical trials, to be published in the April 2006 edition of the American
Journal of Gastroenterology, indicate that NEXIUM(R) (esomeprazole magnesium)
can reduce the incidence of gastric (stomach) ulcers in patients at risk of
developing gastric ulcers and who regularly take either non-selective
nonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2-selective NSAIDs.(1)
NSAIDs are a class of pain relief medications that include traditional,
non-selective drugs, such as ibuprofen, naproxen and aspirin, and newer COX-2-
selective agents. Non-selective NSAIDs are known for increasing the risk of
gastric ulcers, particularly among older patients who take them regularly or
who have a history of gastric ulcers.


Pooled data from the double-blind, randomized, six-month trials showed
that significantly fewer patients taking either NEXIUM 20 mg or NEXIUM 40 mg,
in addition to their regular non-selective NSAID/COX-2-selective therapy,
developed an ulcer at six months, compared to those taking a placebo (5.2
percent and 4.6 percent, respectively, vs. 17 percent, p







AstraZeneca R&D, Sweden, funded the study through a research grant.


About NSAID-ulcer Risk


Chronic NSAID use is a common cause of gastric ulcers and has been
associated with side effects ranging from indigestion to potentially life-
threatening stomach bleeding.(2) Of the more than 14 million Americans who
use NSAIDs regularly to treat chronic pain,(3) up to 25% may be affected by
NSAID-related ulcers.(4) Each year, there are an estimated 103,000
hospitalizations and 16,500 deaths in the United States attributed to
complications from NSAID-associated gastric ulcers.(5) Among the elderly,
NSAID use accounts for nearly one third of gastric-ulcer-related
hospitalizations,(6) with an associated four-fold increased risk of death.(7)


About NEXIUM(R) (esomeprazole magnesium) Delayed-release Capsules


NEXIUM is indicated for reducing the risk of gastric ulcers developing
among at-risk patients on continuous NSAID therapy. Patients are considered
to be at risk if they are age 60 plus or if they have a history of previous
gastric ulcer. NEXIUM also is approved for treating frequent, persistent
heartburn and other symptoms associated with acid reflux disease, as well as
for the healing and maintenance of erosive esophagitis, a condition in which
stomach acid begins to wear away the inner lining of the esophagus. Most
erosions heal in four to eight weeks. Individual results may vary, and only a
doctor can determine if erosions to the esophagus have occurred. Symptom
relief does not rule out the existence of other serious stomach conditions.
The most frequently reported adverse events with NEXIUM include headache,
diarrhea and abdominal pain. For full prescribing information for NEXIUM,
please visit nexium-us.


About AstraZeneca


AstraZeneca (NYSE: AZN) is a major international healthcare business
engaged in the research, development, manufacture, and marketing of
prescription pharmaceuticals and the supply of healthcare services. It is one
of the world's leading pharmaceutical companies with healthcare sales of
$23.95 billion and leading positions in sales of gastrointestinal,
cardiovascular, neuroscience, respiratory, oncology, and infection products.
In the United States, AstraZeneca is a $10.77 billion healthcare business with
more than 12,000 employees. AstraZeneca is listed in the Dow Jones
Sustainability Index (Global) as well as the FTSE4Good Index.
For more information about AstraZeneca, please visit:
astrazeneca-us.


This press release contains forward-looking statements with respect to
AstraZeneca's business. By their nature, forward-looking statements and
forecasts involve risks and uncertainties because they relate to events and
depend on circumstances that will occur in the future. There are a number of
factors that could cause actual results and developments to differ materially.
For a discussion of those risks and uncertainties, please see the company's
Annual Report/Form 20-F for 2005.


References


1 Scheiman JM, et al. (2006) Prevention of Ulcers by Esomeprazole in At-
Risk Patients Using Non-Selective NSAIDs and COX-2 Inhibitors. Am J
Gastroenterology 0 (0), -.doi: 10.1111/j.1572-0241.2006.00499.x.


2 Scheiman JM and Fendrick AM. Practical approaches to minimizing
gastrointestinal and cardiovascular safety concerns with COX-2 inhibitors
and NSAIDs. Arthritis Research & Therapy 2005, 7(Suppl 4):S23-S29.


3 The Dangers of Aspirin and NSAIDs. American College of
Gastroenterology. Available at:

acg.gi/patients/women/asprin.asp.


4 Blower AL. Scand J Rheumatol 1996;25(suppl 105):13-26.

Singh G. Am J Med 1998;105:31S-38S.


5 Wolfe M, Lichtenstein R, Singh G. Gastrointestinal toxicity of
nonsteroidal anti-inflammatory drugs. N Engl J Med 1999;340:1888-1899.


6 Griffin MR et al. Nonsteroidal anti-inflammatory drug use and
increased risk for peptic ulcer disease in elderly persons. Ann Intern
Med 1991;114:257-263.


Griffin MR et al. Nonsteroidal anti-inflammatory drug use and death
from peptic ulcer disease in elderly persons. Ann Intern Med
1988;109:359-363.


Laine L et al. Gastrointestinal health care resource utilization with
chronic use of COX-2-specific inhibitors versus traditional NSAIDs.
Gastroenterology 2003;125:389-395.


(All citations above from Abraham NS et al. National adherence to
evidence-based guidelines for the prescription of nonsteroidal anti-
inflammatory drugs. Gastroenterology 2005;129:1171-1178.)


7 Griffin MR et al. Nonsteroidal anti-inflammatory drug use and death
from peptic ulcer disease in elderly persons. Ann Intern Med
1988;109:359-363. From Abraham NS et al. National adherence to evidence-
based guidelines for the prescription of nonsteroidal anti-inflammatory
drugs. Gastroenterology 2005;129:1171-1178.


AstraZeneca

astrazeneca-us

nexium-us


View drug information on Nexium.

Improved Rheumatoid Arthritis Remission With Combined Therapy

For
patients with active, early stage, moderate-to-severe rheumatoid
arthritis, a combination treatment with methotrexate and etanercept can
improve remission and radiographic non-progression rates within one
year in comparison with just methotrexate. Additionally, more patients
are also able to remain employed. These conclusions are published in an
article released early Online on July 16, 2008 in The Lancet.




Rheumatoid
arthritis is an autoimmune disorder in which the immune system attacks
the joints, causing arthritic inflammation and damage. It can also
extend to other parts of the body. Early in therapy, successful
treatments induce remission, usually by reducing or eliminating
inflammation. If progression of the disease is caught at an early
stage, when it can be most destructive, serious joint damage could be
prevented.



To investigate potential treatment methods for
rheumatoid arthritis, Paul Emery, Professor of Rheumatology, University
of Leeds, UK and Leeds Teaching Hospitals Trust, UK, performed the
COMET study, a randomized trial comparing combination treatment with
individual treatment. A total 542 patients with early
moderate-to-severe RA for 3-24 months who had not been treated with
methotrexate were randomle assigned to one of the following groups:
only methotrexate (268 patients), or methotrexate and etanercept (274
patients). Methotrexate was administered with a starting dose of 7.5 mg
per week to a maximum 20 mg per week at the end of 8 weeks. The
entanercept was administered at 50 mg per week. A disease activity
score (DAS28) was evaluated with a radiographic non-progression measure
(Sharp score) after one year.



It was found that 50% of patients who were given the combined treatment
achieved remission, while 94% of this group had a good to moderate
response. In comparison, the methotrexate only group had a 28%
remission rate, making the combined group members almost twice as
likely to achieve remission. In a comparison of radiographic
non-progression, 80% of combined treatment patients achieved the mark,
while only 58% achieved this in the only methotrexate group. The
serious adverse events were similar in the two groups.



The authors summarize their findings while making a statement about the
increased functionality of patients who are able to bring rheumatoid
arthritis into remission early. "The COMET trial showed that patients
who received combination therapy have a nearly three-fold reduction in
work stoppage compared with those who took high- dose methotrexate
alone. The ability to remain a productive member of the workforce has
implications for patients, employers, and society as a whole. The
effect of RA is especially significant for women aged 55-64 years,
because they have a high incidence of stopping work early...nearly a
quarter of patients who were in employment at baseline in the COMET
trial had stopped working at least once by the end of 1 year compared
with about a tenth in the combination group."



According to the authors, this is data is evidence for the combined
treatment. "The results of the COMET trial suggest that remission is an
achievable goal in patients with early severe RA within the first year
of therapy with etanercept plus methotrexate....The positive clinical
outcomes in the combination treatment group also seem to determine the
ability of patients to remain in employment. Furthermore, these
outcomes appear to be achieved without exposing patients to significant
additional risk."



Dr Joel Kremer, Center for Rheumatology, Albany Medical College,
Albany, NY, USA, contributed an accompanying comment stating that there
must be a specific system for ensuring that this kind of therapy is
cost effective and efficiently implemented. "Experts in health
economics can apply rigorous formulae to quality of life and
disability, while factoring in cost of drugs and their toxic effects,
to establish whether the promising data in these investigations are
sustained, and whether the new biological agents are cost effective."
He says.



Comparison
of methotrexate monotherapy with a combination of methotrexate and
etanercept in active, early, moderate to severe rheumatoid arthritis
(COMET): a randomised, double-blind, parallel treatment trial

Paul
Emery, Ferdinand C Breedveld, Stephen Hall, Patrick Durez, David J
Chang, Deborah Robertson, Amitabh Singh, Ronald D Pedersen, Andrew S
Koenig, Bruce Freundlich

Published Online The Lancet July 16, 2008

DOI:10.1016/S0140- 6736(08)61000-4

Click Here For Journal



COMET's path, and the new biologicals in rheumatoid arthritis

Joel M Kremer

Published Online The Lancet July 16, 2008

DOI:10.1016/S0140- 6736(08)61001-6

Click Here For Journal



Written by Anna Sophia McKenney




Northwestern Memorial Study Tests Cancer Drug On Scleroderma Patients

Physicians at Northwestern
Memorial Hospital are studying the effects of an anti-cancer drug to treat
patients with scleroderma, a rare, incurable autoimmune rheumatic disease
that leads to hardening and tightening of the skin and connective tissues.
Scleroderma affects an estimated 300,000 people in the United States and
can often attack the lungs, heart, kidneys and intestinal tract, and
sometimes lead to death.


The study is the first of its kind to examine if Gleevec, a cancer drug
commonly used to treat leukemia, will treat the skin thickness in
scleroderma patients by blocking the pathway that causes fibrosis. Patients
enrolled in the clinical trial will receive daily oral doses of Gleevec for
six months and will be evaluated initially on a weekly basis at
Northwestern Memorial, one of only three centers nationwide participating
in the study. Others include Johns Hopkins and Boston University Medical
Center.



John Varga, MD, rheumatologist at Northwestern Memorial, John and Nancy
Hughes Distinguished Professor in Rheumatology at Northwestern University's
Feinberg School of Medicine and principal investigator of the study, said
this could be a big step forward for people diagnosed with scleroderma.
"Based on recent research performed by investigators at the Feinberg
School, Gleevec shows potential efficacy in reducing the abnormal skin
changes associated with scleroderma."



The exact cause of Scleroderma, a chronic disease most commonly found
in women between the ages of 30 and 40, remains unknown. Through continued
research, Northwestern Memorial physicians hope to identify treatments to
target the disease and improve the quality of life for patients living with
Scleroderma.



"We hope that the use of Gleevec for a sustained period of time will
decrease the symptoms of skin hardening, and potentially slow the
progression of this devastating disease," adds Dr. Varga.



About Northwestern Memorial Hospital



Northwestern Memorial Hospital is one of the country's premier academic
medical centers and is the primary teaching hospital of the Northwestern
University Feinberg School of Medicine. Northwestern Memorial and its
Prentice Women's Hospital and Stone Institute of Psychiatry have 897 beds
along with 1,424 affiliated physicians and 6,464 employees. Northwestern
Memorial is recognized for providing state-of-the-art patient care and
exemplary clinical and surgical advancements in the areas of cardiothoracic
and vascular care, gastroenterology, neurology and neurosurgery, oncology,
organ and bone marrow transplantation, and women's health. Northwestern
Memorial received the prestigious 2005 National Quality Health Care Award
and is listed in eight specialties in U.S. News & World Report's 2007
rankings for "America's Best Hospitals." For seven years running,
Northwestern Memorial has been rated among the nation's "100 Best Companies
for Working Mothers" by Working Mother magazine and has been chosen by
Chicagoans for more than a decade as their "most preferred hospital"
according to the National Research Corporation's annual survey.
Northwestern Memorial carries the Magnet status designation in nursing, the
highest recognition possible for patient care and nursing excellence.


Northwestern Memorial Hospital

nmh


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