Latest Treatment for Rheumatism
Consideration of biologics
Nowadays, there are more types of biologics, more treatment options, and more expectations for drug withdrawal and hospital visit free. In addition, biosimilars, which are more economical, are now available, and their adoption is helping to lower medical costs. With the advent of biologics, it has become possible to aim for 'remission' and the importance of early treatment has increased. If the disease activity is still high even after starting MTX (severe swelling in large joints such as knees and hips, even if swelling in other joints is mild), early introduction of biologics should be considered.
List of biologics we offer at our clinic
- 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
- HUMIRA
- Remicade IV
- Etanercept BS "MA"
This section lists the biologics that are mainly used.
For other biologics, consult your doctor.
We also adopt biosimilars (bio-generic products) such as Etanercept BS and Infliximab BS.
Prevention and control of infections during administration of biologics
Once a year, x-ray evaluation (to check for progression)
Complications and other medical checks will be performed by an internal medicine doctor.
The hospital takes thorough measures against infectious diseases (pneumonia, tuberculosis, etc.) during rheumatism treatment.
Etanercept Infliximab Adalimumab
What are cytokines?
A type of biologic drug, also called anti-TNF-alpha drug anti-cytokine therapy.
Lymphocytes and other cells secrete a variety of substances that regulate the functioning of the entire body.
In particular, it plays an important role in the functioning of the immune system.
In normal conditions, these cytokines are well balanced, but in patients with rheumatoid arthritis, it has been found that some of these cytokines are produced in excess, causing arthritis and destruction of bones, cartilage and other body tissues.
What is anti-cytokine therapy?
In rheumatoid arthritis patients, a cytokine called TNF-alpha is responsible for the destruction and inflammation of joints in particular.
This treatment suppresses the progression of rheumatoid arthritis by administering drugs that suppress the action of TNF-alpha.
How effective are anti-cytokine therapies?
It is effective for more than 70% of people.
It is a highly effective drug that works dramatically and can be expected to almost eliminate the symptoms. Unlike conventional medications, the effect is immediate (2-3 weeks), and some people say they feel lighter the day after receiving the medication.
How to administer?
Infliximab is administered intravenously. It does not require hospitalization and is administered as an outpatient infusion.
The infusion will be continued at intervals of once every two months. Each infusion takes about 1-2 hours.
Etanercept adalimumab is easily completed by subcutaneous injection, but requires a visit to the clinic at least once every 2-4 weeks. With guidance, you can also self-inject.
About side effects
Mild allergic symptoms such as rashes may occur as with other drugs, but there are no strong side effects like those of anticancer drugs.
Most importantly, the immune system is somewhat compromised, making it easier to develop infections such as tuberculosis and pneumonia.
Will I no longer need MTX or other rheumatic medications?/h3>
MTX and rheumatoid arthritis medication will be continued.
The combination of the two will have the greatest effect.
The first goal is to reduce the amount of prednisone.
About tocilizumab
Tocilizumab (co-developed by Chugai and Osaka University) can be thought of as a drug similar to the two injectable drugs (etanercept and infliximab) that existed until now.
Both are caused by inflammation (a condition in the body that is the source of pain, fever, and swelling. In autoimmune diseases such as rheumatism, the body mistakenly attacks its own tissues).
What is the difference between infliximab and etanercept?
Whereas infliximab etanercept targets a cytokine called TNF-alpha, tocilizumab blocks the action of a cytokine called IL6.
So, even if those two drugs did not work well, or you could not use them due to side effects, you can still expect to benefit.
How to administer?
The infusion is given once every four weeks. It takes about one hour.
The cost is approximately 20,000 yen to 40,000 yen per month for a patient who pays 30% of the cost.
This is almost the same price as etanercept.
What kind of person should we give it to?
In our clinic, we prioritize the use of infliximab, etanercept, and Arava, and use them only for those whose symptoms are still quite severe.
Since these drugs are newly introduced, we will use them with caution.
The target group is those who have not been able to sufficiently relieve their pain even with the combination of MTX and etanercept or infliximab.
Patients will be switched from etanercept or infliximab to tocilizumab, and MTX will continue to be used in combination.
About side effects
As with infliximab etanercept, infectious diseases such as pneumonia and tuberculosis are the most important to watch out for.
I have checked the original papers of clinical trials overseas and in Japan.
I wrote that it is a drug similar to infliximab, but it seems to have some side effects that have not been seen before.
- Leukopenia
- Intestinal perforation (rarely), etc.
Infliximab (approved in the U.S. in 1999 and in Japan in 2003), etanercept (approved in the U.S. in 1998 and in Japan in 2005), and adalimumab (approved in the U.S. in 2001 and in Japan in 2008) have already been used by hundreds of thousands of patients worldwide, and their safety has been established for more than 7-10 years. These three drugs have already been used by hundreds of thousands of patients worldwide and have been proven safe for more than 7-10 years.
MTX (Rheumatrex, Methotrexate, etc.) has been widely used since the 1980s, and its long-term safety has been established for nearly 30 years.
In contrast, the longest clinical trial of Actemra in humans is three years, and the number of cases is in the hundreds.
Therefore, it is possible that some side effects may become apparent only after the drug has been used in thousands of patients.
In particular, both TNF-alpha and IL6 exist in healthy people and perform important functions, so we don't know what the long-term effects of suppressing them with drugs will be on the human body.
For example, although the probability is low, it is possible that a certain type of cancer may occur more frequently in a few years.
About Abatacept (Orencia)
When you develop rheumatoid arthritis, your immune system is activated to attack your body's own tissues, resulting in the phenomenon of inflammation.
Abatacept is a drug that regulates the immune system that has been activated in an abnormal way, bringing it back to a normal state.
The concern with drugs that target inflammatory cytokines, such as infliximab, etanercept, and tocilizumab, is that they also suppress the cytokines needed to protect against infection.
Abatacept is less likely to affect the immune system, which is involved in infection prevention, than drugs such as infliximab.
As a result, the risk of infection is relatively low.
The safety of this drug has been proven through more than 10 years of experience in Europe and the United States.
Its effects on joint swelling and pain caused by rheumatoid arthritis and bone destruction are considered to be almost the same as those of anti-cytokine drugs.
Due to the difference in the mechanism of action, it is a drug that is worth trying for those who have had inadequate results with infliximab and etanercept.
How to administer?
Subcutaneous injections - once a week or once every two weeks, depending on the intensity of the inflammation.
Intravenous administration is also possible.
About side effects
You still need to be very careful about the risk of infection.
