BRASS newsletter 2006 - BRASS: Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study

FDA Approves Two New Drugs for RA –
Abatacept (Orencia) and Rituximab (Rituxan)

by Sarah Bell

You may have heard about two medications recently approved for use in rheumatoid arthritis—abatacept (Orencia) and rituximab (Rituxan). Both treatments are categorized as biologics—medications that mimic the effects of substances made naturally by your immune system.

Abatacept (Orencia):
½ hour infusions every 2 weeks for
the first month, then every 4 weeks

Rituximab (Rituxan):
A single treatment (2 infusions)
often followed up in 6 months.

Other biologics that treat RA are etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira).

Early arthritis medications acted on the immune system as a whole, tending to cause destruction of both diseased and healthy cells. More recently, drugs such as etanercept, infliximab, and adalimumab were developed to block the production of tumor necrosis factor alpha (TNF- ), a protein found in large quantities in rheumatoid joints. In comparison, abatacept and rituximab are engineered to target certain cells that play a role in the overactive immune response. Specifically, RA patients have antibodies that recognize parts of the joint lining as foreign and mount an attack against the body itself. Abatacept works by deactivating T-cells and rituximab focuses on clearing out B-cells. Both types of cells play a role in the overactive immune response. These two new medications help to quell the pain and inflammation of the autoimmune response.

Both medications have been shown in clinical trials to be effective for patients who have not responded well to methotrexate or other biologics. Results show that after six months on abatacept, half of the patients experienced at least a 20% improvement, one out of every five patients experienced a 50% improvement, and one out of every ten patients experienced remission. Similarly, in rituximab trials at week 24, 43% of patients taking rituximab in combination with methotrxate achieved a 50% improvement. Thirty-three percent of patients taking rituximab alone showed a 30% improvement rate.

Both medications have side effects that you should discuss with your rheumatologist.

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	FDA Approves Two New Drugs for RA – Abatacept (Orencia) and Rituximab (Rituxan) by Sarah Bell You may have heard about two medications recently approved for use in rheumatoid arthritis—abatacept (Orencia) and rituximab (Rituxan). Both treatments are categorized as biologics—medications that mimic the effects of substances made naturally by your immune system. Abatacept (Orencia): ½ hour infusions every 2 weeks for the first month, then every 4 weeks Rituximab (Rituxan): A single treatment (2 infusions) often followed up in 6 months. Other biologics that treat RA are etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira). Early arthritis medications acted on the immune system as a whole, tending to cause destruction of both diseased and healthy cells. More recently, drugs such as etanercept, infliximab, and adalimumab were developed to block the production of tumor necrosis factor alpha (TNF- ), a protein found in large quantities in rheumatoid joints. In comparison, abatacept and rituximab are engineered to target certain cells that play a role in the overactive immune response. Specifically, RA patients have antibodies that recognize parts of the joint lining as foreign and mount an attack against the body itself. Abatacept works by deactivating T-cells and rituximab focuses on clearing out B-cells. Both types of cells play a role in the overactive immune response. These two new medications help to quell the pain and inflammation of the autoimmune response. Both medications have been shown in clinical trials to be effective for patients who have not responded well to methotrexate or other biologics. Results show that after six months on abatacept, half of the patients experienced at least a 20% improvement, one out of every five patients experienced a 50% improvement, and one out of every ten patients experienced remission. Similarly, in rituximab trials at week 24, 43% of patients taking rituximab in combination with methotrxate achieved a 50% improvement. Thirty-three percent of patients taking rituximab alone showed a 30% improvement rate. Both medications have side effects that you should discuss with your rheumatologist. page 3

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