To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ACR-DG DISPATCH: Cyclosporine A Lowers Incidence Of Cancer In Patients With Rheumatoid Arthritis URL: http://www.pslgroup.com/dg/C0EA6.htm Doctor's Guide November 11, 1998
By Cameron Johnston Special to DG News SAN DIEGO, CA -- Nov. 11, 1998 -- The immuno-suppressive drug cyclosporine A seems to offer some slight protection against cancer for patients with rheumatoid arthritis (RA), according to the results of a new study presented at the American College of Rheumatology meeting being held in San Diego, CA, from Nov. 8-12, 1998. The findings are important because it has commonly been felt that the incidence of cancers – particularly lympho-proliferative disease -- and skin cancer is higher among RA patients, while cyclosporine itself suppresses the immune system and leaves patients more vulnerable to malignancies. In a recently completed study in The Netherlands, 623 patients with RA were treated with cyclosporine A for periods ranging from one to 11 years between 1984 and 1992. Patients who used cyclosporine A for less than a year experienced 9.1 cases of cancer of any type for every thousand years of patient follow-up, while those who used cyclosporine A for more than a year had 3.1 new cases of cancer per thousand years of follow-up). The number of patients in the control group who developed cancer was 15.2 per thousand for those treated less than a year as compared with 17.2 cases per thousand for those treated more than a year. Researchers caution that the overall reduction in cancer risk was only slight but nonetheless is intriguing given that this was the opposite of what they had anticipated. Omega-3 Fatty Acids Not Beneficial For Mexicans Omega-3 fatty acids -- better known as the substance found in fish oils and in fresh fish that has been linked to a healthier heart and lower rates of arthritis -- does not appear to work its magic in Mexicans with rheumatoid arthritis (RA). Researchers say omega-3 fatty acids are no more effective than sunflower oil at reducing the pain and swelling in the joints in Mexicans with RA. The researchers, from the National Institute of Nutrition in Mexico City, presented these findings at the annual meeting of the American College of Rheumatology this week. In the study, 90 patients with active RA were given 1.5 gr/day of docosapentenaenoic acid and 0.7 gr/day of eicosapentaenoic acid and followed for one year. At the end of the study, no statistically significant differences were reported between the two groups in terms of the number of tender and swollen joints reported, pain scores or physician global assessment. Doctors suggest that the standard Mexican diet, which is high in corn starch, may negate the benefits of fatty acids. Also, the study was conducted in Mexico City, where there is a low overall level of fish consumption and the subjects might have been less likely to benefit from daily supplementary pills containing the fatty acids. Phototoxicity With Non-Steroidal Drugs Is Worse Than Severe Sunburn Large numbers of commonly-used drugs, including virtually all non-steroidal anti-inflammatory drugs (NSAIDs), can have a sudden and painful photo-toxic reaction to sunlight, leaving patients with burns that rival a serious sunburn, researchers at the American College of Rheumatology meeting report. The reaction can occur as soon as 30 minutes after exposure to sunlight and can leave patients hospitalised because of the severity of the burns. Drugs that are linked with serious photo-toxicity include antibiotics such as tetracycline; psoralen and tars used in the treatment of psoriasis; chemotherapy agents such as 5-FU and vinblastine; the antiarrhythmic agent amiodarone; and diuretics such as hydrochlorothiazide, which is used in the treatment of hypertension. The photo-toxic reaction can occur in patients taking as little as 250 mg of naproxen per day – although most patients with arthritis will take 1,000 mg or more mg/day. New Drug Slows Joint Damage Caused By Arthritis, Reduces Pain And Swelling Leflunomide, one of a new class of drugs known as DMARDs (disease modifying anti-rheumatic drugs) -- which actually slow the structural joint damage caused by rheumatoid arthritis rather than simply treating the symptoms -- has been shown to significantly reduce the pain and swelling associated with the disease. The results of a 12-month study comparing Hoechst Marion Roussel's Arava (leflunomide) with placebo and with methotrexate, another commonly used anti-arthritic drug, were presented this week at the American College of Rheumatology meeting in San Diego. In the study, 41 per cent of the patients taking leflunomide showed a 20 percent improvement in disease symptoms, while 19 percent of the patients in the placebo group reported a reduction in disease symptoms. Among patients taking methotrexate, there was a 35 percent reduction in disease symptoms, although 60 percent of those patients doubled their dose during the trial. Leflunomide is the first drug to be approved by the U.S. Food and Drug Administration to retard the structural joint damage caused by rheumatoid arthritis. Glucosamine Offers Benefit For Rheumatoid Arthritis Patients But Formal Studies Can't Prove It Glucosaine sulfate has been used in Europe in the treatment of rheumatoid arthritis for at least a decade now, but the paucity of good published clinical trials means this drug is still ignored as a credible therapy in most countries. Now, researchers at the Boston University Arthritis Center have conducted a meta-analysis looking at the results of six studies to determine whether reports of the drug's efficacy are merely anecdotal, or whether the drug truly does offer a benefit for people with arthritis. Although the drug has been shown in the six trials to benefit arthritis sufferers -- 51 percent of the subjects involved reported a favourable improvement – the studies themselves were methodologically flawed and, therefore, their data might not be reliable, the researchers reported at the American College of Rheumatology meeting. The meta-analysis showed there were no firm protocols governing how the drug was administered or how the subjects were recruited for the studies. The investigators added, however, that because glucosamine has such a favourable side effect profile, it represents an important breakthrough in the treatment of arthritis, even if it shows a modest benefit. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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