NICE, FRANCE, Jul 04 (Reuters Health) - Effective new drugs for the
treatment of arthritis and rheumatism are not reaching patients due to cost
constraints and to a widespread lack of awareness about how best to use them,
specialists told attendees at the recent European Congress of Rheumatology.
"We are living in a exciting period for all patients with arthritis. New
drugs which seem to offer major progress have been introduced, or will soon
become available," said Dr. Thomas Visher of the University Cantonal Hospital in
Geneva, Switzerland, and president of the European League Against Rheumatism
(EULAR).
He noted two new treatments in particular: the anti metabolite, leflunomide
(Arava) and agents which inactivate tumour necrosis factor (TNF) such as
etanercept (Enbrel) and infliximab (Remicade).
To be effective, treatment must not be delayed, noted Dr. Ferdinand
Breedveld of Leiden University Medical Centre in the Netherlands. "It is very
important to start treatment early--'to extinguish the fire before the house is
burnt down', " he commented.
He announced the EULAR initiative called CARE (Collaboration to Assess and
Refer Early) to ensure earlier use of effective rheumatoid arthritis therapies.
"This initiative will teach GPs to recognise the symptoms of (rheumatoid
arthritis) in its earliest phases. This is very important because we know that
irreversible damage may occur during the first few years. Patient organisations
will also work to raise awareness in the wider community," said Breedveld. EULAR
is currently developing the CARE evidence-based guidelines on how to recognise
early rheumatoid arthritis, and how early active treatment will modify long term
outcome, he added.
A further barrier to delivering effective therapy is cost. Although data
presented at EULAR showed that Enbrel was safe, effective and provided rapid and
sustained clinical benefit, could society afford it, Breedveld asked.
"Results from the first three years of treatment in (rheumatoid arthritis)
show that the anti-inflammatory effect of this drug is without precedent. The
problem for many societies is that this is an expensive treatment, costing some
$15,000 per year," he said.
"This is a problem when treating a disease with a prevalence of 0.5 to 1%,
with the potential to break the bank of health budgets in many EU countries if
all patients were treated. The medical community must devise a means of self
restriction by selection of the most appropriate patients," he added.
Dr. Alan Tyndall of the Rheumatologische Universitatsklinik Felix
Platter-Spital in Basel, said that Swiss rheumatologists were currently
negotiating with insurance companies for reimbursement of Enbrel and Remicade.
"The problem is that health insurers do not pay for the social costs of
someone who does not work. We need to bring all these costs together and show
the total savings to society. If you spend $15,000 on a person for a year, and
they return to work, many times this amount may be saved. We need to lobby to
make this happen," he said.
