Matching articles for "Rheumatoid arthritis"
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • November 15, 2021; (Issue 1637)
Rheumatoid arthritis (RA) is prevalent in 0.5% of
adults in the US; it is about 2.5 times more common
in women than in men. Guidelines for treatment
of RA from the American College of Rheumatology
were...
Rheumatoid arthritis (RA) is prevalent in 0.5% of
adults in the US; it is about 2.5 times more common
in women than in men. Guidelines for treatment
of RA from the American College of Rheumatology
were recently updated. The goal of treatment is to
minimize disease activity and prevent irreversible
joint damage.
Expanded Table: Some Biologic Drugs and JAK Inhibitors for Rheumatoid Arthritis (online only)
The Medical Letter on Drugs and Therapeutics • November 15, 2021; (Issue 1637)
...
View Expanded Table: Some Biologic Drugs and JAK Inhibitors for Rheumatoid Arthritis
Expanded Table: Some Conventional DMARDs for Rheumatoid Arthritis (online only)
The Medical Letter on Drugs and Therapeutics • November 15, 2021; (Issue 1637)
...
View Expanded Table: Some Conventional DMARDs for Rheumatoid Arthritis
Flowchart: Rheumatoid Arthritis Treatment (online only)
The Medical Letter on Drugs and Therapeutics • November 15, 2021; (Issue 1637)
...
View the Flowchart: Rheumatoid Arthritis Treatment
In Brief: New Warnings for Janus Kinase Inhibitors
The Medical Letter on Drugs and Therapeutics • October 4, 2021; (Issue 1634)
The FDA has required updates to the boxed warnings
in the labeling of the Janus kinase (JAK) inhibitors
tofacitinib (Xeljanz, Xeljanz XR), baricitinib (Olumiant),
and upadacitinib (Rinvoq) describing...
The FDA has required updates to the boxed warnings
in the labeling of the Janus kinase (JAK) inhibitors
tofacitinib (Xeljanz, Xeljanz XR), baricitinib (Olumiant),
and upadacitinib (Rinvoq) describing increased risks
of major adverse cardiovascular events, malignancy,
thrombosis, and death with their use. The new warnings
were prompted by the results of a postmarketing safety
trial with tofacitinib and were added to the labels of
baricitinib and upadacitinib based on the presumption
of a class effect. The tofacitinib package insert had
contained a boxed warning about an increased risk
of thrombosis and mortality with a dosage of 10 mg
twice daily since 2019, but the new warnings are not
limited by dose.
Upadacitinib (Rinvoq) - A New JAK Inhibitor for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • November 18, 2019; (Issue 1585)
The FDA has approved upadacitinib (Rinvoq –
Abbvie), an oral Janus kinase (JAK) inhibitor, for
treatment of adults with moderately to severely
active rheumatoid arthritis (RA) who have had
an inadequate...
The FDA has approved upadacitinib (Rinvoq –
Abbvie), an oral Janus kinase (JAK) inhibitor, for
treatment of adults with moderately to severely
active rheumatoid arthritis (RA) who have had
an inadequate response to or cannot tolerate
methotrexate (Trexall, and others). Upadacitinib is
the third JAK inhibitor to be approved in the US for
treatment of RA; tofacitinib (Xeljanz, Xeljanz XR)
and baricitinib (Olumiant) were approved earlier.
Qmiiz ODT - An Orally Disintegrating Meloxicam Tablet
The Medical Letter on Drugs and Therapeutics • September 23, 2019; (Issue 1581)
The FDA has approved Qmiiz ODT (TerSera), an orally
disintegrating tablet formulation of the prescription
NSAID meloxicam. Qmiiz ODT, like conventional oral
meloxicam tablets (Mobic, and generics), is...
The FDA has approved Qmiiz ODT (TerSera), an orally
disintegrating tablet formulation of the prescription
NSAID meloxicam. Qmiiz ODT, like conventional oral
meloxicam tablets (Mobic, and generics), is indicated
for relief of the symptoms of osteoarthritis (OA) and
rheumatoid arthritis (RA) in adults and of juvenile RA
in children who weigh ≥60 kg. Vivlodex, a low-dose
capsule formulation of meloxicam, is FDA-approved
only for management of OA pain.
In Brief: Risk of Pulmonary Thromboembolism and Death with Tofacitinib (Xeljanz)
The Medical Letter on Drugs and Therapeutics • August 26, 2019; (Issue 1579)
The FDA has required updates to the labeling of the Janus kinase (JAK) inhibitor tofacitinib (Xeljanz, Xeljanz XR) based on interim results of a postmarketing safety trial that showed an increased risk of...
The FDA has required updates to the labeling of the Janus kinase (JAK) inhibitor tofacitinib (Xeljanz, Xeljanz XR) based on interim results of a postmarketing safety trial that showed an increased risk of pulmonary thromboembolism and death with a dosage of 10 mg twice daily.1 Tofacitinib is approved for treatment of rheumatoid arthritis (RA),2 psoriatic arthritis, and ulcerative colitis.
In the postmarketing trial, RA patients ≥50 years old taking methotrexate who had at least one cardiovascular risk factor were randomized to receive add-on treatment with tofacitinib 5 mg twice daily (the FDA-approved dosage for RA and psoriatic arthritis), tofacitinib 10 mg twice daily (an approved dosage for ulcerative colitis), or a tumor necrosis factor (TNF) inhibitor. At the time of the interim analysis in January 2019 (~3900 patient-years of data in each group), pulmonary thromboembolism had occurred in 19 patients taking tofacitinib 10 mg twice daily and in 3 patients taking a TNF inhibitor; 45 patients taking tofacitinib 10 mg twice daily and 25 taking a TNF inhibitor had died. Interim data from the 5-mg twice daily group have not been made available by the FDA. After the interim analysis, patients taking the higher dose of tofacitinib were transitioned into the 5 mg twice daily group; the trial is ongoing.3
Serious, sometimes fatal thromboembolic adverse events have also occurred with use of baricitinib (Olumiant),4 another JAK inhibitor that is FDA-approved for treatment of RA. Whether an increased risk of thromboembolism is a class effect of JAK inhibitors remains to be determined; RA itself has been associated with an increased thromboembolic risk.5
The tofacitinib package insert now contains a boxed warning describing the increased risk of thrombosis and mortality with a dosage of 10 mg twice daily and emphasizes that this dosage or Xeljanz XR 22 mg once daily is not recommended for treatment of RA or psoriatic arthritis. For treatment of ulcerative colitis, tofacitinib is now only indicated in patients who have had an inadequate response or intolerance to TNF inhibitors; for these patients, the 10-mg twice daily dosage is still recommended as induction therapy for 8 weeks (can be continued for up to 16 weeks) and for maintenance treatment when there is loss of response to a dosage of 5 mg twice daily.
Download complete U.S. English article
In the postmarketing trial, RA patients ≥50 years old taking methotrexate who had at least one cardiovascular risk factor were randomized to receive add-on treatment with tofacitinib 5 mg twice daily (the FDA-approved dosage for RA and psoriatic arthritis), tofacitinib 10 mg twice daily (an approved dosage for ulcerative colitis), or a tumor necrosis factor (TNF) inhibitor. At the time of the interim analysis in January 2019 (~3900 patient-years of data in each group), pulmonary thromboembolism had occurred in 19 patients taking tofacitinib 10 mg twice daily and in 3 patients taking a TNF inhibitor; 45 patients taking tofacitinib 10 mg twice daily and 25 taking a TNF inhibitor had died. Interim data from the 5-mg twice daily group have not been made available by the FDA. After the interim analysis, patients taking the higher dose of tofacitinib were transitioned into the 5 mg twice daily group; the trial is ongoing.3
Serious, sometimes fatal thromboembolic adverse events have also occurred with use of baricitinib (Olumiant),4 another JAK inhibitor that is FDA-approved for treatment of RA. Whether an increased risk of thromboembolism is a class effect of JAK inhibitors remains to be determined; RA itself has been associated with an increased thromboembolic risk.5
The tofacitinib package insert now contains a boxed warning describing the increased risk of thrombosis and mortality with a dosage of 10 mg twice daily and emphasizes that this dosage or Xeljanz XR 22 mg once daily is not recommended for treatment of RA or psoriatic arthritis. For treatment of ulcerative colitis, tofacitinib is now only indicated in patients who have had an inadequate response or intolerance to TNF inhibitors; for these patients, the 10-mg twice daily dosage is still recommended as induction therapy for 8 weeks (can be continued for up to 16 weeks) and for maintenance treatment when there is loss of response to a dosage of 5 mg twice daily.
- FDA drug safety communication: FDA approves boxed warning about increased risk of blood clots and death with higher dose of arthritis and ulcerative colitis medicine tofacitinib (Xeljanz, Xeljanz XR). July 26, 2019. Available at: www.fda.gov. Accessed August 15, 2019.
- Tofacitinib for rheumatoid arthritis. Med Lett Drugs Ther 2013; 55:1.
- FDA drug safety communication: Safety trial finds risk of blood clots in the lungs and death with higher dose of tofacitinib (Xeljanz, Xeljanz XR) in rheumatoid arthritis patients; FDA to investigate. February 25, 2019. Available at: https://www.fda.gov. Accessed August 15, 2019.
- Baricitinib (Olumiant) for rheumatoid arthritis. Med Lett Drugs Ther 2018; 60:120.
- IC Scott et al. Thromboembolism with Janus kinase (JAK) inhibitors for rheumatoid arthritis: how real is the risk? Drug Saf 2018; 41:645.
Download complete U.S. English article
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 30, 2018; (Issue 1552)
Disease-modifying antirheumatic drugs (DMARDs)
are used for initial treatment of rheumatoid arthritis
(RA) to achieve clinical remission and prevent
irreversible joint damage (see Table 1). DMARDs
generally...
Disease-modifying antirheumatic drugs (DMARDs)
are used for initial treatment of rheumatoid arthritis
(RA) to achieve clinical remission and prevent
irreversible joint damage (see Table 1). DMARDs
generally do not have an immediate analgesic effect,
but over time they can control symptoms and have
been shown to delay and possibly stop progression
of the disease. Methotrexate (Trexall, and others)
is generally the drug of choice; it can be used for
patients with low, moderate, or high disease activity.
For mild disease, some clinicians prefer to start with
hydroxychloroquine (Plaquenil, and generics) and/or
sulfasalazine (Azulfidine, and others).
Expanded Table: Biologic Agents for Rheumatoid Arthritis (online only)
The Medical Letter on Drugs and Therapeutics • July 30, 2018; (Issue 1552)
...
View Expanded Table: Biologic Agents for Rheumatoid Arthritis
Expanded Table: Conventional DMARDs for Rheumatoid Arthritis (online only)
The Medical Letter on Drugs and Therapeutics • July 30, 2018; (Issue 1552)
...
View Expanded Table: Conventional DMARDs for Rheumatoid Arthritis
Baricitinib (Olumiant) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 16, 2018; (Issue 1551)
The FDA has approved the Janus kinase (JAK) inhibitor
baricitinib (Olumiant – Lilly) for oral treatment of adults
with moderately to severely active rheumatoid arthritis
(RA) that has not responded...
The FDA has approved the Janus kinase (JAK) inhibitor
baricitinib (Olumiant – Lilly) for oral treatment of adults
with moderately to severely active rheumatoid arthritis
(RA) that has not responded adequately to one or more
tumor necrosis factor (TNF) inhibitors. Baricitinib is
the second JAK inhibitor to be approved for treatment
of RA; tofacitinib (Xeljanz, Xeljanz XR) was the first.
Comparison Table: Some Nonopioid Analgesics for Pain (online only)
The Medical Letter on Drugs and Therapeutics • February 12, 2018; (Issue 1540)
...
View the Comparison Table: Some Nonopioid Analgesics for Pain
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • February 12, 2018; (Issue 1540)
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future...
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future issue.
Tocilizumab (Actemra) for Giant Cell Arteritis
The Medical Letter on Drugs and Therapeutics • September 25, 2017; (Issue 1530)
The FDA has approved the interleukin-6 (IL-6) receptor
antagonist tocilizumab (Actemra – Genentech) for
subcutaneous (SC) treatment of giant cell arteritis
in adults. It is the first drug to be approved in...
The FDA has approved the interleukin-6 (IL-6) receptor
antagonist tocilizumab (Actemra – Genentech) for
subcutaneous (SC) treatment of giant cell arteritis
in adults. It is the first drug to be approved in the US
for this indication. Tocilizumab is also approved for
treatment of rheumatoid arthritis, polyarticular or
systemic juvenile idiopathic arthritis, and cytokine
release syndrome.
Sarilumab (Kevzara) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • August 14, 2017; (Issue 1527)
The FDA has approved the interleukin (IL)-6 inhibitor
sarilumab (Kevzara – Sanofi) for second-line
treatment of adults with moderately to severely
active rheumatoid arthritis (RA). It is the second...
The FDA has approved the interleukin (IL)-6 inhibitor
sarilumab (Kevzara – Sanofi) for second-line
treatment of adults with moderately to severely
active rheumatoid arthritis (RA). It is the second IL-6
inhibitor to be approved for this indication; tocilizumab
(Actemra) was approved earlier.
Inflectra - An Infliximab Biosimilar
The Medical Letter on Drugs and Therapeutics • January 30, 2017; (Issue 1513)
The FDA has approved infliximab-dyyb (Inflectra –
Pfizer; marketed as Remsima in some countries), as a
biosimilar of the TNF inhibitor infliximab (Remicade).
Infliximab-dyyb was approved in the European...
The FDA has approved infliximab-dyyb (Inflectra –
Pfizer; marketed as Remsima in some countries), as a
biosimilar of the TNF inhibitor infliximab (Remicade).
Infliximab-dyyb was approved in the European Union
(EU) in 2013 and in Canada in 2014. It is the second
biosimilar to be approved by the FDA. Filgastrim-sndz
(Zarxio), a recombinant human granulocyte colony-stimulating
factor, was the first.
Drugs for Psoriatic Arthritis (online only)
The Medical Letter on Drugs and Therapeutics • June 8, 2015; (Issue 1470)
Psoriatic arthritis is a chronic inflammatory arthropathy
that develops in up to 40% of patients with
psoriasis. Several guidelines for treatment of psoriatic
arthritis have been...
Psoriatic arthritis is a chronic inflammatory arthropathy
that develops in up to 40% of patients with
psoriasis. Several guidelines for treatment of psoriatic
arthritis have been published.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • December 22, 2014; (Issue 1458)
For initial treatment of rheumatoid arthritis, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to...
For initial treatment of rheumatoid arthritis, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to control symptoms. Methotrexate is generally the DMARD of choice...
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used early in the treatment of rheumatoid arthritis (RA) to achieve clinical remission, prevent irreversible damage to joints, and minimize toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. DMARDs generally do not have an immediate analgesic effect, but over time can control symptoms and have been shown to delay and possibly stop progression of the disease. Methotrexate (Rheumatrex, and others) is generally the first DMARD prescribed; it can be used to treat mild, moderate, or severe RA. For mild disease, some clinicians prefer to start with hydroxychloroquine (Plaquenil, and generics) and/or sulfasalazine (Azulfidine, and others).
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used early in the treatment of rheumatoid arthritis (RA) to achieve clinical remission, prevent irreversible damage to joints, and minimize toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. DMARDs generally do not have an immediate analgesic effect, but over time can control symptoms and have been shown to delay and possibly stop progression of the disease. Methotrexate (Rheumatrex, and others) is generally the first DMARD prescribed; it can be used to treat mild, moderate, or severe RA. For mild disease, some clinicians prefer to start with hydroxychloroquine (Plaquenil, and generics) and/or sulfasalazine (Azulfidine, and others).
In Brief: Otrexup - A Single-Use Auto-Injector Formulation of Methotrexate
The Medical Letter on Drugs and Therapeutics • March 31, 2014; (Issue 1439)
The FDA has approved a new injectable formulation of methotrexate (Otrexup – Antares) for use in rheumatoid arthritis and polyarticular juvenile idiopathic arthritis, and for severe psoriasis in adults. On...
The FDA has approved a new injectable formulation of methotrexate (Otrexup – Antares) for use in rheumatoid arthritis and polyarticular juvenile idiopathic arthritis, and for severe psoriasis in adults. On its web site (www.otrexup.com), the manufacturer states: "Otrexup is the first subcutaneous (SC) methotrexate (MTX) for self-administration delivered once weekly by auto-injector." Methotrexate has been available as a once-weekly injection (IM or SC) for these indications for many years,1 but not specifically for self-administration and not in a single-dose auto-injector. Methotrexate is generally given orally, but injectable formulations may be helpful for patients who have adverse gastrointestinal effects from the oral formulation or lose benefit over time because of poor absorption.
Otrexup auto-injectors are available in strengths of 10, 15, 20, and 25 mg of methotrexate per 0.4 mL. The usual dosage of methotrexate for patients with rheumatoid arthritis ranges from 7.5 to 25 mg once weekly. Otrexup should be administered SC in the abdomen or thigh. Four 25-mg auto-injectors cost $548.00, compared to $5.00 for a single 4-mL vial of generic methotrexate containing 25 mg/mL.2 Nevertheless, some patients with rheumatoid arthritis who find it difficult to draw up methotrexate solution from a vial and inject it with a syringe may prefer Otrexup.
1. Drugs for rheumatoid arthritis. Treat Guidel Med Lett 2012; 10:37.
2. Approximate wholesale acquisition cost (WAC). Source: Analy$ource® Monthly (Selected from FDB MedKnowledge™) March 5, 2014. Reprinted with permission by FDB, Inc. All rights reserved. ©2014. www.fdbhealth.com/policies/drug-pricing-policy. Actual retail prices may be higher.
Download complete U.S. English article
Otrexup auto-injectors are available in strengths of 10, 15, 20, and 25 mg of methotrexate per 0.4 mL. The usual dosage of methotrexate for patients with rheumatoid arthritis ranges from 7.5 to 25 mg once weekly. Otrexup should be administered SC in the abdomen or thigh. Four 25-mg auto-injectors cost $548.00, compared to $5.00 for a single 4-mL vial of generic methotrexate containing 25 mg/mL.2 Nevertheless, some patients with rheumatoid arthritis who find it difficult to draw up methotrexate solution from a vial and inject it with a syringe may prefer Otrexup.
1. Drugs for rheumatoid arthritis. Treat Guidel Med Lett 2012; 10:37.
2. Approximate wholesale acquisition cost (WAC). Source: Analy$ource® Monthly (Selected from FDB MedKnowledge™) March 5, 2014. Reprinted with permission by FDB, Inc. All rights reserved. ©2014. www.fdbhealth.com/policies/drug-pricing-policy. Actual retail prices may be higher.
Download complete U.S. English article
Canakinumab (Ilaris) for Systemic Juvenile Idiopathic Arthritis
The Medical Letter on Drugs and Therapeutics • August 19, 2013; (Issue 1423)
The FDA has approved the interleukin-1 (IL-1) beta
inhibitor canakinumab (Ilaris – Novartis) for treatment of
systemic juvenile idiopathic arthritis (sJIA; formerly
called juvenile rheumatoid arthritis or...
The FDA has approved the interleukin-1 (IL-1) beta
inhibitor canakinumab (Ilaris – Novartis) for treatment of
systemic juvenile idiopathic arthritis (sJIA; formerly
called juvenile rheumatoid arthritis or Still’s disease) in
children ≥2 years old. Canakinumab was approved earlier
for treatment of cryopyrin-associated periodic syndromes
(CAPS). Tocilizumab (Actemra), an interleukin-6
(IL-6) inhibitor that has been available since 2010 for
treatment of rheumatoid arthritis in adults, was also
recently approved by the FDA for sJIA. Canakinumab is
the only IL-1 inhibitor approved for this indication.
Tofacitinib (Xeljanz) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • January 7, 2013; (Issue 1407)
The FDA has approved tofacitinib (toe” fa sye’ ti nib;
Xeljanz – Pfizer), an oral Janus kinase (JAK) inhibitor, for
treatment of adults with moderately to severely active
rheumatoid arthritis (RA) who...
The FDA has approved tofacitinib (toe” fa sye’ ti nib;
Xeljanz – Pfizer), an oral Janus kinase (JAK) inhibitor, for
treatment of adults with moderately to severely active
rheumatoid arthritis (RA) who have had an inadequate
response to or are intolerant of methotrexate. Ruxolitinib
(Jakafi) is the only other JAK inhibitor available in the
US; it is FDA-approved for treatment of myelofibrosis.
Delayed-Release Prednisone (Rayos)
The Medical Letter on Drugs and Therapeutics • November 26, 2012; (Issue 1404)
The FDA has approved a delayed-release oral formulation
of prednisone (Rayos – Horizon Pharma). Rayos is
not labeled for any specific indication, but the only
published studies of the new product have been...
The FDA has approved a delayed-release oral formulation
of prednisone (Rayos – Horizon Pharma). Rayos is
not labeled for any specific indication, but the only
published studies of the new product have been in
patients with rheumatoid arthritis (RA).
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2012; (Issue 117)
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize...
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize toxicity
associated with nonsteroidal anti-inflammatory drugs
(NSAIDs) and corticosteroids. DMARDs (Table 1)
generally do not have an immediate analgesic effect,
but over time can control symptoms and have been
shown to delay and possibly stop progression of the
disease. NSAIDs have immediate analgesic and antiinflammatory
effects, but may not affect the disease
process. Oral corticosteroids can relieve joint symptoms
and control systemic manifestations, but their
chronic use can cause many complications. Judicious
use of intra-articular corticosteroids can rapidly
decrease inflammation in acute joints with few, if any,
adverse effects.
A Fixed-Dose Combination of Ibuprofen and Famotidine (Duexis)
The Medical Letter on Drugs and Therapeutics • October 31, 2011; (Issue 1376)
The FDA has approved Duexis (Horizon), a fixed-dose
combination of the nonsteroidal anti-inflammatory drug
(NSAID) ibuprofen and the H2-receptor antagonist
(H2RA) famotidine, for symptomatic relief of...
The FDA has approved Duexis (Horizon), a fixed-dose
combination of the nonsteroidal anti-inflammatory drug
(NSAID) ibuprofen and the H2-receptor antagonist
(H2RA) famotidine, for symptomatic relief of osteoarthritis
and rheumatoid arthritis and to decrease the risk of
developing gastric and duodenal ulcers in patients at
risk for NSAID-associated ulcers. Vimovo, a combination
of the NSAID naproxen and the proton pump
inhibitor (PPI) esomeprazole, is also approved by the
FDA for prevention of NSAID-associated gastric ulcers.
Naproxen/Esomeprazole (Vimovo)
The Medical Letter on Drugs and Therapeutics • September 20, 2010; (Issue 1347)
The FDA has approved the marketing of Vimovo
(AstraZeneca), a fixed-dose combination of the nonsteroidal
anti-inflammatory drug (NSAID) naproxen
and the proton pump inhibitor (PPI) esomeprazole,...
The FDA has approved the marketing of Vimovo
(AstraZeneca), a fixed-dose combination of the nonsteroidal
anti-inflammatory drug (NSAID) naproxen
and the proton pump inhibitor (PPI) esomeprazole, for
symptomatic relief of osteoarthritis, rheumatoid arthritis
and ankylosing spondylitis and to decrease the risk
of developing gastric ulcers in patients at risk for
NSAID-associated ulcers.
Tocilizumab (Actemra) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • June 14, 2010; (Issue 1340)
The FDA has approved tocilizumab (Actemra – Genentech; RoActemra in Europe) for intravenous
(IV) treatment of adult patients with moderately to severely active rheumatoid arthritis who have had...
The FDA has approved tocilizumab (Actemra – Genentech; RoActemra in Europe) for intravenous
(IV) treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an
inadequate response to tumor necrosis factor (TNF) inhibitors.
Which TNF Inhibitor for Rheumatoid Arthritis?
The Medical Letter on Drugs and Therapeutics • May 17, 2010; (Issue 1338)
The FDA has approved five tumor necrosis factor (TNF) inhibitors for treatment of moderately to
severely active rheumatoid arthritis (RA). TNF-α is a pro-inflammatory cytokine involved in the...
The FDA has approved five tumor necrosis factor (TNF) inhibitors for treatment of moderately to
severely active rheumatoid arthritis (RA). TNF-α is a pro-inflammatory cytokine involved in the pathogenesis of many systemic inflammatory disorders.
Golimumab (Simponi) for Inflammatory Arthritis
The Medical Letter on Drugs and Therapeutics • July 13, 2009; (Issue 1316)
Golimumab (Simponi - Centocor), a fully humanized anti-tumor necrosis factor (TNF)-a antibody, has been approved by the FDA for the treatment of: (1) moderate to severe active rheumatoid arthritis (RA) in...
Golimumab (Simponi - Centocor), a fully humanized anti-tumor necrosis factor (TNF)-a antibody, has been approved by the FDA for the treatment of: (1) moderate to severe active rheumatoid arthritis (RA) in combination with methotrexate; (2) active psoriatic arthritis (PsA) alone or in combination with methotrexate; and (3) active ankylosing spondylitis (AS).
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2009; (Issue 81)
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal...
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Rituximab (Rituxan) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • April 24, 2006; (Issue 1233)
Rituximab (Rituxan - Genentech), an anti-CD20 monoclonal antibody already marketed for treatment of B-cell non-Hodgkin's lymphoma, is now FDA-approved for use concurrently with methotrexate to treat moderate to...
Rituximab (Rituxan - Genentech), an anti-CD20 monoclonal antibody already marketed for treatment of B-cell non-Hodgkin's lymphoma, is now FDA-approved for use concurrently with methotrexate to treat moderate to severe rheumatoid arthritis in patients who have had an inadequate response to one or more tumor necrosis factor (TNF) inhibitors. Rituximab selectively depletes CD20+ B cells, which apparently play a role in the autoimmune response and in the chronic synovitis associated with rheumatoid arthritis.
Abatacept (Orencia) for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • February 27, 2006; (Issue 1229)
Atacept (Orencia - Bristol-Myers Squibb), an inhibitor of T-cell activation, has been approved by the FDA for treatment of moderate to severe rheumatoid arthritis (RA) in patients who have not responded to one...
Atacept (Orencia - Bristol-Myers Squibb), an inhibitor of T-cell activation, has been approved by the FDA for treatment of moderate to severe rheumatoid arthritis (RA) in patients who have not responded to one or more disease-modifying anti-rheumatic drugs (DMARDs).
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • December 1, 2005; (Issue 40)
To prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) are now used...
To prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA). The DMARDs listed in the table on page 84 have no immediate analgesic effects, but can control symptoms and have been shown to delay and possibly stop progression of the disease. The NSAIDs listed in the table on page 88 have analgesic and anti-inflammatory effects, but may not affect the disease process. Oral corticosteroids can rapidly relieve joint symptoms and control systemic manifestations, but their chronic use is associated with many complications.
NSAID Alternatives
The Medical Letter on Drugs and Therapeutics • January 17, 2005; (Issue 1200)
Patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) may be asking their health care providers if they should continue, and some may be asking for alternatives. For most patients taking nonspecific...
Patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) may be asking their health care providers if they should continue, and some may be asking for alternatives. For most patients taking nonspecific NSAIDs, it would be reasonable to continue. For those who are taking the COX-2 selective celecoxib (Celebrex) because they cannot tolerate the gastrointestinal (GI) effects of nonspecific NSAIDs, it seems reasonable to continue at doses no higher than 100 mg b.i.d. or 200 mg once daily; at these dosages cardiovascular risk has been no higher than with placebo. All NSAIDs, including COX-2 inhibitors, can decrease renal blood flow and cause fluid retention, hypertension and renal failure, especially in the elderly and in patients who take diuretics. The unpublished study that led to an FDA alert on an increased cardiovascular risk with naproxen (Naprosyn, and others) was conducted in patients older than 70. See NSAID addendum
Adalimumab (Humira) For Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • March 31, 2003; (Issue 1153)
Adalimumab (Humira - Abbott), a tumor necrosis factor alpha (TNF-α) inhibitor, has been approved by the FDA for treatment of moderate to severe rheumatoid arthritis (RA). A genetically engineered human...
Adalimumab (Humira - Abbott), a tumor necrosis factor alpha (TNF-α) inhibitor, has been approved by the FDA for treatment of moderate to severe rheumatoid arthritis (RA). A genetically engineered human IgG1 monoclonal antibody, adalimumab is approved for subcutaneous (SC) injection in adults who have failed at least one disease-modifying anti-rheumatic drug (DMARD), for use either alone or with other DMARDs such as methotrexate (Rheumatrex, and others). Two other TNF-α antagonists, etanercept (Enbrel) and infliximab (Remicade), are already on the market for treatment of RA (Treatment Guidelines from The Medical Letter 2003; 1:25).
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • January 1, 2003; (Issue 5)
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect...
Many different drugs are now used to treat rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), listed in the table on page 26, have analgesic and anti-inflammatory effects, but may not affect the disease process. Corticosteroids can provide rapid relief of joint symptoms and control of systemic manifestations, but chronic use is associated with many complications. The "disease-modifying" anti-rheumatic drugs (DMARDs), listed on page 29, have no immediate analgesic effects, but can control symptoms and may delay progression of the disease (American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines, Arthritis Rheum 2002; 46:328). Interactions of anti-rheumatic drugs with other drugs are listed in The Medical Letter Handbook of Adverse Drug Interactions, 2003.
Valdecoxib (Bextra) - a New Cyclooxygenase-2 Inhibitor
The Medical Letter on Drugs and Therapeutics • April 29, 2002; (Issue 1129)
Valdecoxib (Bextra - Pharmacia/Pfizer), a selective cyclooxygenase (COX-2) inhibitor similar to celecoxib (Celebrex) and rofecoxib (Vioxx), was recently approved by the FDA for treatment of osteoarthritis,...
Valdecoxib (Bextra - Pharmacia/Pfizer), a selective cyclooxygenase (COX-2) inhibitor similar to celecoxib (Celebrex) and rofecoxib (Vioxx), was recently approved by the FDA for treatment of osteoarthritis, rheumatoid arthritis and primary dysmenorrhea.
Meloxicam (Mobic) for Osteoarthritis
The Medical Letter on Drugs and Therapeutics • May 29, 2000; (Issue 1079)
Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID) with some cyclooxygenase-2 (COX-2) selectivity in vitro, has been approved by the FDA for treatment of...
Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID) with some cyclooxygenase-2 (COX-2) selectivity in vitro, has been approved by the FDA for treatment of osteoarthritis.
New Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • November 20, 1998; (Issue 1040)
Leflunomide (Arava - Hoechst Marion Roussel), which inhibits pyrimidine synthesis, and etanercept (Enbrel - Immunex/Wyeth-Ayerst), which blocks the action of tumor necrosis factor (TNF), have been approved by...
Leflunomide (Arava - Hoechst Marion Roussel), which inhibits pyrimidine synthesis, and etanercept (Enbrel - Immunex/Wyeth-Ayerst), which blocks the action of tumor necrosis factor (TNF), have been approved by the FDA for treatment of rheumatoid arthritis. A third drug, infliximab (Remicade - Centocor), which also blocks TNF and has been used to treat rheumatoid arthritis, was approved earlier for treatment of Crohn's disease. Its use in Crohn's disease will be reviewed in a future issue.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • November 11, 1994; (Issue 935)
Many different drugs are now used to treat rheumatoid arthritis. Apirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) listed in the table on page 102 have analgesic and anti-inflammatory effects, and...
Many different drugs are now used to treat rheumatoid arthritis. Apirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) listed in the table on page 102 have analgesic and anti-inflammatory effects, and they are relatively safe. The second-line drugs listed on page 106 have no immeadiate analgesic effects, but they can control symptoms and may delay progression of the disease. NSAIDs usually are taken concurrently with the slower acting second-line drugs, which, with the exception of methotrexate, may take months to produce a therapeutic response (JM Cash and JH Klippel, N Engl J Med, 330:1368, May 12, 1994).
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • July 12, 1991; (Issue 848)
...
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • June 30, 1989; (Issue 795)
Many different drugs are now used to treat rheumatoid arthritis. Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (Motrin; and others), Naproxen (Naprosyn; and others) and, most...
Many different drugs are now used to treat rheumatoid arthritis. Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (Motrin; and others), Naproxen (Naprosyn; and others) and, most recently, diclofenac (Voltaren - Medical Letter, 30:110, 1988), have immediate analgesic and anti-inflammatory effects, and they are relatively safe. The second-line of drugs used for treatment of rheumatoid arthritis include hydroxychloroquine, gold, penicillamine, azathioprine, sulfasalazine and methotrezate. These agents, which have no immediate analgesic effects, can control symptoms and may possibly delay progression of the disease, but they can also cause severe adverse effects. NSAIDs are usually taken concurrently with the slower acting second-line drugs, which may take months to produce a therapeutic response. but may not affect the disease process.