It All Comes Out in the Wash: Comparing Different Treatments & Approaches

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unwashed hairFour weeks. Not a record for me, but close… When this is published in the morning, I’ll be spending the morning washing and blowing out my hair for the 1st time in about a month.

The ends started to take dreadlock form the last few days, somewhat an improvement. But the front looks really bad [deliberately not in photo]. My neck is a bit better today and I’m going for it! It will be a very long day of errands, meetings, and phone conferences, but it will feel good to look “normal.”

Does that sound random? Bear with me.

Yesterday, I was speaking with someone who needed to understand RA patients’ point of view for her project for a pharma company. And she didn’t (understand).

Giving her free advice, I told her that my neck and hands have hurt too much to make it worthwhile to wash my hair. She hesitated to believe me, maybe because she’s been told that medication helps everyone with Rheumatoid disease to feel close to normal on most days, with maybe occasional flares.

Finally, I told her: Look, there is a small percentage of people who have remission or mild RA who can do the things you suggest, but that is not your audience anyway since your drug is for people with “moderate to severe RA,” right? Make sure you don’t insult anyone…

Of course, people with RA do not yet have THE silver bullet. And researchers know that. That’s why they investigate how treatments stack up against each other. Here are two interesting studies I’ve read recently.

Seeing “very little difference among the current biologics”

In “Abatacept versus other biologics in methotrexate inadequate responders with rheumatoid arthritis: you like tomato and I like tomahto… let’s call the whole thing off,” Yusuf Yazici (a colleague of Dr. Ted Pincus), comments on current studies that compare biologics: “(A)s far as efficacy is concerned, there is very little difference among the current biologics.” Yazici says there are more pressing matters to explore to improve patients’ lives. “It is time to stop picking favorites among the biologic agents and focus on how we can get more physicians to monitor RA outcomes that would allow us to be as aggressive as RA demands us to be.”

Comparing less expensive triple DMARD therapy to Enbrel plus methotrexate

Over several years, the TEAR Trial has examined early, aggressive RA to compare oral DMARD combination therapy (methotrexate, sulfasalazine, and hydroxychloroquine /Plaquenil) to methotrexate plus etanercept (Enbrel), asking:

  1. Whether any combination therapy (three DMARDs or methotrexate with etanercept) is more effective than methotrexate alone, with a step-up approach.
  2. How does combination therapy compare to methotrexate plus a TNF Biologic?

RA Tear Trial fig 3


“The treatment of rheumatoid arthritis (RA) has changed dramatically over the past decade” and there is a need to know whether one approach is proven to be more effective, especially considering how costly Biologics are. The primary outcome of the trial was the popular disease activity score, DAS28-ESR between weeks 48 and 102, and this showed no difference between the two treatment approaches. However, the etanercept plus methotrexate patients had a “smaller increase in radiographic scores” (x-rays of hands, wrists, and feet).

More interesting points: “We observed a higher rate of participants not completing the study than we had originally expected.”  Dropout rate was 32.1%, and most of those who decided not to continue cited lack of efficacy or did not provide a reason. The screenshot of figure 3 shows that both immediate therapy (IT or IE) groups had more patients who reached ACR response levels than those with step-up approach.

Nope. No silver bullet yet. Of course the marketing folks can’t talk to the researchers, but I wonder whether the researchers laugh when they watch the commercials that make treatments seem like a cure. Anyway, I hope both of them will talk to patients more.

Recommended reading

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Kelly Young. All rights reserved.

This entry was posted on Friday, April 20th, 2012 at 5:00 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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