A treatment for ankylosing spondylitis bites the dust… next
Otezla Fails In Ankylosing Spondylitis Study
Dr. Jack Cush writing in RheumNow reported that ClinicalTrials.gov has listed the results of the POSTURE study, a large randomized placebo-controlled trial wherein apremilast (Otezla) was found to yield no benefit (compared to placebo) in treating ankylosing spondylitis (AS) (32.5% vs. 36.6% ASAS20 at week 16) patients. These findings make it unlikely that Celgene will pursue AS as an indication for apremilast.
Comment: I’m not surprised. Otezla’s effects are modest.
Study Shows Potential for Early Diagnosis of Arthritis
Pat Anson writing for Pain News Network reported a new study by British researchers has demonstrated the potential for an experimental blood test that can diagnose arthritis in its earliest stages. Such a test could lead to earlier treatment of osteoarthritis (OA) and rheumatoid arthritis (RA), years before joint damage and physical symptoms begin.
Researchers at Warwick Medical School recruited 225 people with early or advanced OA, RA or another inflammatory joint disease, along with a control group of healthy volunteers with no joint problems. Their blood and fluid from affected knee joints were then analyzed with mass spectrometry.
The test found patterns in blood plasma amino acids that were damaged by oxygen, nitrogen and sugar molecules. The damage was highest in the blood samples of patients with OA or RA, and markedly lower in the blood of healthy volunteers — giving researchers identifiable biomarkers that could be used for an early diagnosis.
“This is a big step forward for early-stage detection of arthritis that will help start treatment early and prevent painful and debilitating disease,” said Naila Rabbani, PhD, of Warwick Medical School. “Damage to proteins in the arthritic joint have been known for many years but this is the first time it has been exploited for early-stage diagnosis.
“For the first time we measured small fragments from damaged proteins that leak from the joint into blood. The combination of changes in oxidised, nitrated and sugar-modified amino acids in blood enabled early stage detection and classification of arthritis – osteoarthritis, rheumatoid arthritis or other self-resolving inflammatory joint disease.”
When Cheap Generic Drugs Morph Into Expensive Prescriptions
Dr. Jack Cush writing in Rheumnow reported The Wall Street Journal has issued an alarming trend in generic drug pricing that affects many, especially the elderly and those with arthrtis.
Pharmaceutical companies have developed a growing number of combined generic products whose sum is far more than the cost of the individual generics. For example, the migraine medication Treximet has two active ingredients—sumatriptan and naproxen. As generics these two drugs may result in a copay of zero dollars for the average patient.
A box of nine tablets of Treximet costs $728.67, according to Truven Health Analytics. But the average actual cost for a box is about $353, and the cost of its two constituents, sumatriptan and naproxen, would cost around $19, according to GoodRx.
Others combo agents in this category include acne cream Acanya, Duexis and Vimovo for arthritis pain and the weight-loss pill Qsymia.
Comment: Pharmaceutical companies can be sneaky I think.
So… you need knee replacement. Should you get them done one at a time or both at once… next
Simultaneous Versus Staged Bilateral Total Knee Arthroplasty
Dr. Jack Cush writing in Rheumnow reported on a metanalysis from 2013 that identified 18 articles which included over 65,000 patients and compared those undergoing single as opposed to simultaneous total knee replacements.
The incidence of mortality was significantly higher in the simultaneous group at 30 days (RR 3.67, 95% CI 1.68–8.02), 3 months (RR 2.45, 95% CI 2.15–2.79) and 1 year (RR 1.85, 95% CI 1.66–2.06) after surgery.
On the other hand there were no significant differences between the two groups with regard to in-hospital mortality R 1.18, 95% CI 0.74–1.88), post-operative deep vein thrombosis, cardiac complications, and pulmonary embolism or infection rates
Thus the higher mortality rate associated with bilateral total knee arthroplasty should impact patient selection for this surgical option. The good news is that there is no differences in other common complications associated with arthroplasty – infection, thrombotic events, etc.
Do the immunosuppressive drugs used in rheumatoid arthritis treatment increase cancer risk? The answer next…
Most immunosuppressive drugs do not significantly increase the risk of breast cancer recurrence
Dr. Lara Pullen writing in Arthritis and Rheumatology reported on a study involving 3 large populations of women with rheumatoid arthritis or inflammatory bowel disease who had undergone surgery for primary breast cancer. What the researchers found was that the risk of breast cancer recurrence in patients who received methotrexate or anti-TNF therapy did not have a significant risk of breast cancer recurrence.
Comment: I think this is reassuring news for clinicians who choose to start methotrexate or anti-TNF therapy in rheumatoid arthritis or inflammatory bowel disease patients with treated breast cancer.