Leflunomide use during early pregnancy is associated with fetal malformations in animal studies and is classified as a pregnancy category X by the U.S. Food and Drug Administration. However, little is known about pregnancy outcomes in humans exposed to leflunomide in early pregnancy, particularly in those who receive “wash-out” with cholestyramine (a drug sequestrant). Here, […]
Recently, it has been recognized that a subset of T cells producing the cytokine IL-17 contribute to the pathogenesis of rheumatoid arthritis (RA). Animal studies have suggested that blockade of IL-17 may reduce the inflammatory signs and symptoms of inflammatory arthritis and reduce bone erosion. Here, Genovese et al report Phase I/II data for LY2439821, […]
Reactivation of latent tuberculosis is a recognized risk of TNF inhibitor use. While there has been circumstantial evidence of greater risk with the monoclonal antibody TNF inhibitors (e.g. infliximab and adalimumab) compared with decoy receptor TNF inhibitors (e.g. etanercept), there have been few direct comparisons. Here, Dixon et al (Ann Rheum Dis 2010; 69: 522-528) […]
Treatment with rituximab, a monoclonal antibody targeting CD20+ B cells, could adversely affect immunization responses by dampening the antibody response from new vaccination or reducing pre-formed antibody from prior vaccination. However, little systematic investigation of immunization responses has been undertaken. Here, two studies concurrently published in Arthritis & Rheumatism explore responses after influenza vaccination (van […]
On January 8, 2010, the U.S. Food and Drug Administration approved tocilizumab (to be marketed under the trade name of Actemra) for the treatment of patients with moderate to severe rheumatoid arthritis who have had inadequate clinical responses to treatment with TNF inhibitors. Tocilizumab is a humanized monoclonal antibody directed against the receptor for IL-6, […]
Rheumatoid arthritis disease activity tends to improve during pregnancy, even when disease modifying agents are stopped. However, a minority of women with rheumatoid arthritis will continue to have active disease during pregnancy, and may require additional immunosuppression. Prior studies have yielded conflicting reports on the influence of active disease during pregnancy. Here, de Man et […]
While most observational studies have not demonstrated an increase in malignancy independently associated with TNF inhibitor use, a meta-analysis of short-term clinical trials data suggested an increase in malignancy risk occurring within months of initiating therapy with monoclonal antibodies directed against TNF-α (infliximab and adalimumab).
Initial combination therapy has been shown to be superior to step-up combination therapy in groups of RA patients; however, these findings are difficult to reconcile with the observation that many RA patients will have complete remission of disease on methotrexate alone. Practice patterns tend to emphasize initial treatment with methotrexate monotherapy, followed by the addition of other agents in combination for those with inadequate responses.
Tai Chi, a popular form of exercise involving stylized and controlled movements, has been advocated as a way to manage pain, maximize function, and improve quality of life for a variety of chronic musculoskeletal conditions, including osteoarthritis, rheumatoid arthritis, and fibromyalgia. However, the evaluation of its efficacy in these conditions has been limited by the […]
The U.S. Food and Drug Administration has approved the use of certolizumab pegol (which will be marketed under the trade name Cimzia) for the treatment of moderate to severe rheumatoid arthritis (RA). Certolizumab pegol is a novel TNF inhibitor comprised of an antigen-binding domain of a humanized TNF antibody coupled to polyethylene glycol (PEG) to […]