I read this article on cnn.com, and thought of you guys.  Looks like there
will be a new class of rheumatoid arthritis drugs coming along.....

Katherine

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http://www.cnn.com/2004/HEALTH/conditions/06/18/arthritis.drug.ap/index.html

Drug makes 'smart' assault on arthritis

BOSTON, Massachusetts (AP) -- For the first time, a drug has relieved
rheumatoid arthritis by knocking out a certain type of immune cell -- an
approach that could open the way for precisely targeted, "smart" treatments
for the joint disease and other illnesses, too.

Other arthritis drugs on the market either treat just the symptoms, or
employ a broader, more scattershot effect against the underlying process.
Such drugs can have toxic side effects because they kill healthy cells along
with the diseased ones.

The latest research, an international study led at University College London
and published in Thursday's New England Journal of Medicine, looked at a
drug called rituximab, and the results were promising.

"I think this is a pivotal study," said Dr. John Klippel, president of the
Arthritis Foundation. "This is opening up a new era of targeted biologic
therapies for rheumatoid arthritis."

In rheumatoid arthritis, antibodies misdirect friendly fire against the
body's own joint linings. Joints become inflamed, swollen and painful. More
than 2 million Americans, mostly women, have the disease.

Rituximab, which is sold under the brand name Rituxan and is already
approved for non-Hodgkin's lymphoma, targets B cells, which manufacture
these antibodies.

The researchers compared rituximab to other drugs in 161 patients with
arthritis.

For two weeks, patients took rituximab alone or in combination with two
other drugs: the standard drug, methotrexate, and the less widely used
cyclophosphamide. Another group took methotrexate alone. Roche, a
distributor of rituximab, funded and participated in the study.

After six months, more than 40 percent of patients who took rituximab
combinations were greatly improved. One-third of patients on rituximab alone
were greatly improved. But only 13 percent of those on the standard drug
alone improved that much.

"One of the things that is truly unique is that a very short course ...
appears to have a very long-lasting effect," Klippel said.

Some doctors, including the study's authors, said rituximab needs more
testing before any widespread use. They said other B-cell-killing drugs are
under development and could eventually outperform rituximab.

Researchers are also testing similar targeted approaches against lupus,
multiple sclerosis and other autoimmune diseases.

Both methotrexate and cyclophosphamide are sometimes employed as
chemotherapy drugs and attack a broader range of tissue than rituximab. The
newer drug kills close to 90 percent of B cells, which the body then
replenishes with healthy new ones.

Rituximab is one of the most narrowly aimed and efficient members in the
modern family of targeted drugs that include the breast cancer treatment
Herceptin.

Of all the tested treatments for rheumatoid arthritis, "it goes closest to
the root of the disease," said the study's lead author, Dr. Jonathan Edwards
of University College London.

However, the drug could pose a danger of chest infection, especially if
given repeatedly, Edwards said. One rituximab patient in the study died of
pneumonia, though it was not clear if the drug was responsible.