4/16/2021 9:43:49 PM
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  • Advances in Rheumatology: Strides Made in Treating Rheumatoid Arthritis and Gout

    Patients who cope with the potentially incapacitating pain and complications associated with rheumatic diseases such as rheumatoid arthritis and gout rely on effective treatment options. Advancement in the therapies that are available can help improve quality of life for many patients.

    A common chronic inflammatory disorder is rheumatoid arthritis (RA), which occurs when the immune system attacks the lining of the membranes that surround joints. In order to slow down the progression of joint damage, disease-modifying antirheumatic drugs (DMARDs) are often prescribed. Unfortunately, many DMARDs come with boxed warnings and have significant side effects. For example:

    • Methotrexate (MTX), a commonly used DMARD, can cause rash, stomach upset, liver/bone marrow toxicity, or birth defects.
    • The long-term use of Imuran (azathioprine) is associated with an increased risk of cancer.
    • Xeljanz (tofacitinib) (a JAK inhibitor) carries a boxed warning for serious infections, cancers, and lymphoma.
    • Humira (adalimumab) and Enbrel (etanercept) both include boxed warnings for serious infections and lymphomas.

    Although DMARDs have a wide range of possible side effects, including stomach upset, liver problems, and low white/red blood cell counts, many patients can achieve remission while taking them. At that point, a physician may decide to decrease or stop the DMARD. The decision of when to taper DMARDs is an important, widely discussed topic that will be explored at the American College of Rheumatology Annual Meeting in November 2016.

    Exciting prospects for new therapies are emerging, with several promising drugs for treatment of RA on the horizon. One of these is baricitinib. This oral JAK 1 and 2 inhibitor has a completed phase III study with results showing that significantly more patients with RA who received baricitinib had clinical improvement compared to placebo at 12 weeks. Another product in the pipeline is decernotinib. The phase II study of this oral JAK 3 inhibitor showed that decernotinib significantly improved signs/symptoms of RA at weeks 12 and 24 compared with the placebo group when administered in combination with MTX. Emergent products such as these offer new options for patients with RA who may have had an inadequate response to other therapies.

    Product advancement in rheumatology continues with intriguing new pharmacotherapy to treat gout. Zurampic (lesinurad) is a recent approval for treating hyperuricemia associated with this painful form of arthritis. If hyperuricemia results in the formation of uric acid crystals, gout can develop, often leading to the onset of intense pain and swelling in the joints. It commonly appears first as redness, soreness, and swelling in the big toe. Zurampic inhibits the function of transporter proteins involved in uric acid reabsorption by the kidney, thus aiding the kidney to excrete the uric acid. Side effects associated with Zurampic include headache, influenza, increased blood creatinine, and GERD. It also has a boxed warning to advise healthcare professionals of the risk for acute renal failure.

    For informative labeling details on thousands of products, such as those used to treat rheumatic diseases, visit PDR.net. Please update or register your PDR profile to receive alerts and other critical drug information from PDR via email. Also, look for information from PDR within your eRx workflow. Drug safety information, updates about dosing and formulary, patient support programs, and savings opportunities display on your screen as you prescribe, at no cost to you or your patients. To learn more about PDR services in your eRx/EMR/EHR workflow, email us at EHR-info@PDR.net.

    Salvatore Volpe, MD, FAAP, FACP, CHCQM
    Chief Medical Officer