Pollyanna Penguin’s RA Blog
This is a blog about me, my recently diagnosed rheumatoid arthritis and my struggles to stay positive about it!Archive for anti-TNF
And another one!
The EU are keeping busy with their approvals programme. Simponi (golimumab) is another biologic just approved for rheumatoid arthritis. It’s approved for moderate to severe R.A. either in conjunction with methotrexate or on its own.
More evidence that Abatacept IS effective in treating R.A.
Current NICE guidelines say that Abatacept (one of the many biologics, anti-TNFs) should not be used in R.A. patients who have not responded to other biologics. Now a Cochrane Review (a review designed to help policy makers and healthcare workers make decisions on what is and isn’t effective) says that Abatacept IS effective in R.A. treatment. NICE are already in the process of reviewing their current guidance, but a decision is not expected until June 2010. The review strongly recommends that for the moment Abatacept is not used WITH other biologics – but says nothing about use if other biologics have been tried and have failed, which suggests that perhaps NICE should be recommending it for those with rheumatoid arthritis who have failed on other anti-TNFs.
Like all anti-TNFs, how safe it is in the long term has not yet been established – because none of them have been around long enough, but the Cochrane review (by Dr. Lisa Maxwell in Ottawa) showed that patients given Abatacept were twice as likely to achieve a 50% improvement in symptoms such as pain and the number of tender and swollen joints.
In the meantime a study on intranasal administration of recombinant Human Cartilage glycoprotein-39 for treatment of R.A. has failed. Personally I don’t fancy a regular treatment via my nostrils … although if I had moderate to severe R.A. I guess I’d try anything once! However it didn’t show any improvement over placebo, so I dare say I will never need to try that one. Phew.
NICE refuses yet another drug for R.A.
NICE have rejected yet another R.A. drug – this time for ‘moderate to severe R.A.’ It’s RoActemra (tocilizumab), known as Actemra in the U.S. apparently.
OK, so right now this isn’t a huge personal concern for me – apart from the ’scrofulous pustule’ and other minor unpleasant side effects, the methotrexate is doing its job; but it’s a huge concern for R.A. patients in the U.K. in general, and potentially also for me personally in the future.
Here’s a link to an article about it, as there’s no point in me saying everything that’s already been said … and that I’ve already said about other drugs on this blog! In brief, and I quote: “the Committee has concluded that, at an approximate cost of £9,295 a year for a patient weighing approximately 70 kg, the therapy is just too expensive for use on the NHS and would not represent a cost-effective use of resources.”
I’d better start losing weight now, as if I ever need anti-TNFs in future NICE will probably decide it’s too expensive to fund overweight patients, as underweight patients need less drug! Well I suppose if NICE are inadvertently making me lose weight, that’s one positive benefit of them!
A real breakthrough in RA treatment? Maybe!
Could the news that rituximab (MabThera) can provide dramatically improved results in patients with early rheumatoid arthritis be a real breakthrough at last? The thing I find most encouraging about the research, carried out by Prof. Paul-Peter Tak from the University of Amsterdam, is that it’s research based on a drug that’s already out there in the market, not something we’ll have to wait ten years for approval for.
Tak (which means thank-you in Norwegian, something many of us might want to say to him if this research is taken through into treatment) showed that treating patients early with rituximab and methotrexate in combination, can virtually stop the disease in its tracks. The 755 patient trial of recently diagnosed patients, most of whom had suffered the disease for less than a year, showed that nearly 2.5 times as many patients on the treatment went in to remission, compared with those treated with methotrexate alone.
Of course, like all RA treatments (to date, anyway) it doesn’t work for everyone, and so far the investigation has only been on recently diagnosed patients, but it certainly sounds encouraging. At the moment in the UK rituximab is only prescribed after failure of anti-TNF therapy, but NICE might actually take this option seriously as the cost of rituximab is about a quarter of an anti-TNF so it makes economic as well as medical sense to try rituximab first.
Here’s hoping NICE do something sensible for once!
Alternative Medicine – v – Conventional Medicine
A lot of alternative medicine is good. It’s ‘alternative’ because it’s not been proven scientifically in double-blind trials, but that doesn’t mean it doesn’t work. It might just mean that no one has enough interest in funding the trials or, more to the point, sees enough profit in doing so. Full scientific investigation complete with clinical trials is an extremely expensive business.
However, a lot of conventional medicine is also good, and that’s something that a lot of alternative medicine aficionados tend to forget … and in fairness vice versa is certainly also true.
The biggest pity, to my mind, is the divide that says the one has to be ‘versus’ the other. Most consultants dismiss any alternative therapies out of hand, and most alternative therapists, in my experience, are pretty keen to dismiss conventional medicine. There are moves to get the two working together, but it’s going to be a long hard slog to get the two practices talking to each other, an then keep them at it, I think.
Something to remember with regard to RA though is that forty or so years ago conventional medicine had no effective treatment. The recommended course of treatment was bed rest, which did precisely nothing to help. Even twenty or thirty years ago, you’d be put on high doses of aspirin and not a lot else. As a rule the patient went from bad to worse, as RA is generally, if left uncontrolled, a progressive disease. In the short time from then to now there are many more or less effective treatments on the market, a large number of RA sufferers have their disease halted in its tracks, and some are even in remission. The medicines might not work for ever, but, for many people, they do work. They might also cause nasty side effects, but it’s important to remember that they might NOT. Reading the list of side effects on a packet of tablets is pretty scary – what it tends not to say is, ‘Only one percent of people get this one’ or ‘only ten percent of people get that one’ and a lot of people assume that if they try the medication they’ll get ‘em all.
Now anti-TNFs have come on to the market too, and the possibilities of treatment, if the costs can be brought under control, look relatively rosy. So, while I’m all for living a healthier lifestyle (if not very good at it myself, she says munching on another chocolate), and it might well have huge benefits for your RA (or rather huge benefits for getting rid of your RA), don’t disregard conventional medicine out of hand!
And finally, conventional medicine doesn’t claim to understand RA fully, know everything about it, or know how to cure it: I think anyone who does make those claims is highly suspect.
(And if you think this is controversial, just wait for the post I haven’t written yet about drug companies and how they’re actually not all a hundred percent evil)
Great news! NASTY are doing something NICE
NRAS has just announced that NICE, the so called ‘National Institute for Health and Clinical Excellence’ and unaffectionately known as NASTY, which is in fact a national organisation for making sure expensive drugs don’t get paid for on the National Health Service, is re-opening its enquiry into whether a patient should be allowed to try another anti-TNF drug if the first fails to work.
Admittedly this is not a total reversal of their previous Final Appraisal Document, which indicated that patients should not be allowed to try another anti-TNF if the first failed, even in the face of overwhelming evidence that a) patients who ‘failed’ on one anti-TNF frequently had success with another, as these drugs are all quite differnet and work in different ways to each other and b) a patient who had failed on this last line of treatment was likely to already be suffering from severe RA (Because in this country you can’t have an anti-TNF at all on the NHS unless your RA is severe, even though evidence suggests that the earlier you treat with an anti-TNF, the more succesful you are).
The fact that NICE have ‘backed down’ to the extent of even revisiting this is great news though, and it proves that they are forced to listen when we all stand up and shout! Thanks to NRAS and all the other organisations who appealed against the Final Appraisal Document. No thanks to my MP, who did at least stir himself to write a letter to the Minister for Health but then failed to understand her response and sent me a useless letter saying something like ‘It’s OK – this hasn’t actually been decided yet’.
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