Arthritis

Updated 21 December 2015

Expensive biological drug makes little difference

An expensive biological drug was no better than cheaper, conventional therapy in terms of reducing time off from work for rheumatoid arthritis sufferers, a new study finds.

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Swedish researchers assessed lost work days among rheumatoid arthritis patients who had not responded to initial treatment with a standard medication, methotrexate.

The group of 204 patients were randomly given either the biological drug infliximab (Remicade) or conventional combination therapy with the non-biologics sulfasalazine plus hydroxychloroquine.

At the start of the study, the average amount of lost work time was 17 days per month for all patients. During the 21-month study, the patients receiving conventional therapy lost about six fewer days of work per month, compared with about five fewer days for those taking Remicade – not a significant difference.

Regardless of the drugs used, early and aggressive treatment for patients who've failed to respond to methotrexate "not only stops the trend of increasing work loss days but partly reverses it", concluded researchers led by Jonas Eriksson of the Karolinska Institute in Stockholm.

No difference

However, the team say they "did not find any difference" in terms of work absentee rates depending on which drugs the patients took, even though Remicade did seem to provide "significantly improved disease control".

Experts not connected to the study said the relative price tags of these drugs is another key factor to consider.

"Currently, there are nine biologics FDA-approved for the treatment of rheumatoid arthritis," explained Dr Steven Carsons, chief of the division of rheumatology, clinical immunology and allergy at Winthrop-University Hospital in Mineola, NY.

However, he said that biologics can cost between $15,000 to $20,000 per year, while the two non-biologics included in the Swedish study might cost only a tenth of that amount.

So, the new findings are "reassuring in terms of having effective, lower-cost alternatives with established safety profiles available for patients who do not have coverage for the more expensive biologics", Carsons said.

Different responses

He added, however, that in the "real world" each patient responds differently to various rheumatoid arthritis medications, and many do fare much better on a biologic drug.

Another rheumatologist, Dr Diane Horowitz of North Shore University Hospital in Manhasset, NY, said the new study "brings into question the utility of choosing the more expensive [treatment] option" if ability to function well at work is a key consideration.

It's not clear, however, if the work-related benefits of a biologic would improve over a longer period of use. According to Horowitz, who is also a rheumatologist at Long Island Jewish Medical Center in New Hyde Park, NY, "further research needs to be done" to answer that question.

The study was published on 1 July in the journal JAMA Internal Medicine.



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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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