Study: No Benefit to Costly Arthritis Meds

Traditional Drugs Work as Well as Newer, More Expensive Ones

(WebMD)  For many people with rheumatoid arthritis, the traditional, and much cheaper, disease-modifying antirheumatic drugs (DMARDs) appear to work just as well as newer TNF blockers that target the underlying disease process, a large study shows.

The findings also suggest that a step-up approach in which patients are started on methotrexate alone, with additional drugs added only if needed, may be preferable to immediate combination treatment, says Larry W. Moreland, MD, chief of rheumatology at University of Pittsburgh.

Moreland and colleagues studied 755 patients, mostly white women. All had early rheumatoid arthritis, with an average of less than four months since diagnosis, and had not yet received disease-modifying antirheumatic drugs (DMARDs).

The study was designed to compare the older and the newer drugs and to look at the benefit of starting with combination therapy compared to step-up therapy.

The patients were divided into four groups. Two groups began with immediate combination therapy: either methotrexate combined with sulfasalazine and hydroxychloroquine (the traditional DMARDs) or methotrexate and the TNF blocker Enbrel.

The other two groups began with methotrexate alone, with step-up treatment adding either sulfasalazine/hydroxychloroquine or Enbrel only if they had persistent disease activity at six months.

Arthritis Drugs: No Difference Between DMARDs, TNF Blockers
Two years later, there was no significant difference in disease activity between patients taking triple DMARD therapy or methotrexate plus Enbrel. This held true whether they received immediate combination treatment or step-up therapy.

"What this means in real clinical practice is that patients should be started on methotrexate alone, with other drugs added only if they don't respond," Moreland says.

"You always want to try to expose the patient to as few drugs as possible," he says.

Although the traditional DMARDs worked just as well in the study as the TNF blocker, Moreland isn't ready to conclude that holds true for all patients.

"While the results may show that, overall, both treatments have similar outcomes, we still are not certain how to best treat individual patients," he says.

Moreland tells WebMD that X-ray images, taken during the study, may show whether one strategy is better at halting disease progression. But those images aren't available yet.

"We clearly need better predictors of who will benefit from which treatment," says Mayo Clinic rheumatologist John Davis, MD. He moderated a news conference to discuss the new studies at the annual meeting of the American College of Rheumatology.

In the meantime, Davis tells WebMD he tries to prescribe the least aggressive treatment that works.

"I have patients that do very well on methotrexate alone," he says.

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The pharmaceutical companies, like most corporations, exist to make a profit. They may advertise heavily to make themselves appear concerned with patient health, but, the truth is, they're primarily concerned with profits. We can't entirely condemn them, as they invest billions of dollars bringing their products to market, and they need to make that money back, and profit for their risk taking. In addition, many of the products they've developed are very helpful, and have improved patient quality of life tremendously. However, the pharmaceutical copmanies, in their persuit of profit, have done a tremendous amount of harm to society as well. Sadly, in recent years, the harm has far outweighed the benefits. Arthritis "treatments" are a classic case in point. Little, if any attempt is made to understand why the human body attacks itself (as is the case with rheumatoid arthritis). That would lead to a cure for arthritis, and, the pharmaceuticals have learned that there isn't much money in cures. The money is in the "treatments", which require a patient to return again and again for additional doses of medication or "treatments". The patient becomes dependent on the "treatment", and, like any addict, will pay any price for it. As a result, arthritis research has focused, almost entirely, on "medications" which supress the immune system.

Let me suggest to everyone who has rheumatoid arthritis that you visit the following website: www.roadback.org, and explore antibiotic protocal. In my opinion, this is a far safer, and more effective approach. It's also a whole lot less expensive than the newer, patented drugs being pushed by the pharmaceutical companies today.

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Actually, in my comments above, I neglected to say that research has focused almost entirely on two areas: imunosuppressants (supressing the immune system) and anti inflamatory drugs. The anti inflamatory drugs, which I neglected to mention have received almost as much attention as the imunosuppressants. However, all they do is prevent the body from having an inflamatory reaction to the autoimmune disorder which is rheumatoid arthritis. In other words, they prevent the body from producing certain proteins which are linked to inflammation in the joints and connective tissue. However, most of them also block proteins which regenerate the lining of the stomach, causing ulsers. One of the so called "cox 2 inhibitors", Vioxx was found to block a protein important for the heart as well. However, since continual use of the protein inhibitors is required for continued blockage of the proteins related to inflamation, the patient is dependent on their perpetual usage. In addition to ulsers, the patient is also subjected to liver damage from the anti inflamatory drugs, so, they're as potentially damaging as the imunosuppresants. Again, I suggest antibiotic tharapy for rheumatoid arthritis, using a tetracycline derivative, such as minocyn or minocycline. If you have rheumatoid arthritis, or any closely related disease, I strongly urge you to spend some time researching the website www.roadback.org. It has a wealth of information regarding this type of minimally damaging, yet highly effective and inexpensive treatment for many forms of arthris and autoimmune difficiencies.