The latest treatment for RA
Examination of biopharmacy
Nowadays, the variety of biopharmacy products is increasing, the treatment options are expanding, and it is expected that drug suspension and outpatient treatment will be free. In addition, highly economical biosimilar drugs have also appeared, and by adopting them, medical expenses can be reduced. With the advent of biopharmacy, it has become possible to aim for'relief'as a therapeutic goal, and early treatment has become even more important. If disease activity is still high after starting MTX (even if the swelling of large joints such as the knees and hips is strong, or the swelling of other joints is mild), biopharmacy should be introduced early. Consider.
List of biopharmacy use in our hospital
- Actemra drip
- Actemra subcutaneous injection
- Infliximab BS 100mg "NK" for intravenous drip infusion
- Enbrel subcutaneous injection
- Orencia subcutaneous injection
- Cimzia subcutaneous injection
- Simponi subcutaneous injection
- Remicade IV
- Etanercept BS "MA"
The main biopharmacy products are listed.
For other biopharmacy, please consult with a doctor.
We also use biosimilars (generic bio products) such as etanercept BS and infliximab BS.
Prevention and countermeasures for infectious diseases during administration of biopharmacy
X-ray evaluation once a year (check if it is not progressing)
We perform complications by internal medicine Dr and other internal medicine checks.
At this hospital, we thoroughly take measures against infectious diseases (pneumonia, tuberculosis, etc.) during RA treatment.
Etanercept Infliximab Adalimumab
What is a cytokine?
A type of biopharmacy, also called anti-TNF alpha drug, anti-cytokine therapeutic drug.
It is a substance secreted by cells such as lymphocytes, and there are various types that regulate the function of the body throughout the body.
In particular, it plays an important role in the function of immunity.
Under normal conditions, these cytokines are well-balanced, but in patients with rheumatoid arthritis, some of these cytokines are overproduced, causing arthritis and at the same time their own bones and cartilage. It has become clear that it is destroying the tissues of the body.
What is anti-cytokine therapy?
TNF-α is a cytokine that causes joint destruction and inflammation in patients with RA.
It is a treatment that suppresses the progression of RA by administering a drug that suppresses the action of TNF-α.
It is effective for more than 70% of people.
It is a highly effective drug and can be expected to work dramatically and eliminate symptoms. Unlike conventional medicines, it is characterized by immediate effects (2-3 weeks), and some people say that the body became lighter the day after it was administered.
How to administer?
Infliximab is given by intravenous drip. No hospitalization is required, and an outpatient drip is given.
Continue to infuse once every two months. It takes about 1-2 hours for one infusion.
Etanercept adalimumab is easily completed by subcutaneous injection, but requires a minimum visit every 2-4 weeks. With guidance, you can also self-inject.
About side effects
Mild allergic symptoms such as rashes may occur like other drugs, but they do not have the strong side effects of anticancer drugs.
Most importantly, the immune system is slightly weakened, making it more likely to develop infectious diseases such as tuberculosis and pneumonia.
Will I no longer need RA medications such as MTX ?
Continue to take MTX and RA medications.
The combination of the two produces the maximum effect.
The first goal is to reduce the amount of prednisolone.
Tocilizumab (co-developed by Chugai and Osaka University) can be thought of as a drug that is roughly similar to the two injectable drugs (etanercept + infliximab) that have been used up until now.
Both are inflammations in the body (the condition of the body that is the source of pain, fever, and swelling. Usually, it occurs when your body's immune system is fighting foreign substances such as bacteria and viruses, In autoimmune diseases such as RA, it mistakenly attacks the tissues of one's body) = a drug that blocks the action of cytokines.
How is it different from Infliximab Etanercept?
Infliximab etanercept targets a cytokine called TNFα, whereas tocilizumab blocks the action of a cytokine called IL6.
Therefore, even if the two drugs did not work very well or could not be used due to side effects, the effect can be expected.
How to administer?
Intravenous drip once every 4 weeks. It takes about 1 hour.
Please think that the cost is about 20,000 to 40,000 yen for those who bear 30% per month.
It's about the same as Etanercept.
How to administer
At our hospital, we give priority to infliximab, etanercept, alaba, etc., and only use them for people with severe symptoms.
This is a newly introduced drug, so use it with caution.
The subjects were those who did not get enough pain with MTX in combination with etanercept or infliximab.
Switch from etanercept or infliximab to tocilizumab and continue to use MTX.
About side effects
As with infliximab and etanercept, infectious diseases such as pneumonia and tuberculosis are of the utmost caution.
Regarding side effects, I checked the original texts of clinical trial papers from overseas and Japan.
I wrote that it is a drug similar to infliximab, but it seems that there are side effects that have not been seen until now.
- Intestinal perforation (rarely), etc.
Infliximab (1999 in the US, approved in Japan 2003), etanercept (1998 in the US, 2005 in Japan), and adalimumab (2001 in the US, 2008 in Japan) are already used by more than hundreds of thousands of patients worldwide. , 7-10 years or more of safety has been established.
MTX (Rheumatrex Methotrexate) has been widely used since the 1980s and has established long-term safety for nearly 30 years.
In contrast, Actemra is a human clinical trial case with a maximum length of 3 years and hundreds of cases.
Therefore, side effects that will become apparent for the first time after being used by thousands of patients after launch are possible.
In particular, both TNFα and IL6 are present in healthy people and play an important role, so we do not know what kind of effect the drug will have on the human body in the long term.
For example, although the probability is low, it is possible that some types of cancer will occur frequently in a few years.
About Abatacept (Orencia)
When rheumatoid arthritis develops, immunity is activated and attacks the tissues of one's body, resulting in a phenomenon called inflammation.
Abatacept is a drug that regulates the abnormally activated immune system and brings it closer to normal.
There is concern that drugs targeting inflammatory cytocan, such as infliximab etanercept and tocilizumab, also suppress cytokines needed to defend against infection.
Compared to infliximab, abatacept is less likely to affect the immune system involved in infection protection.
Therefore, it is considered to be a drug with a relatively low risk of infectious diseases.
Safety has been proven by accumulating usage experience in Europe and the United States for more than 10 years.
The effect of rheumatism on joint swelling / pain and bone destruction is almost the same as that of anti-cytokine therapeutic agents.
Due to the difference in the mechanism of action, it is a drug that is worth trying even for those who have insufficient effects such as infliximab and etanercept.
How to administer?
Subcutaneous injection-Depending on the intensity of inflammation, it is given once a week or once every two weeks.
It can also be administered by intravenous drip.
About side effects
After all, you need to be careful about the risk of infectious diseases.
Check with your doctor for other biopharmacy.