A new drug for the treatment of rheumatoid arthritis (RA), Actemra (tocilizumab), has demonstrated superiority over the existing standard of therapy (methotrexate): after 6 months of taking the drug, there is a more significant reduction in the severity of symptoms of the disease (swelling and tenderness of the joints) in patients suffering from RA1. Moreover, with Actemra, approximately 3 times more patients (compared to methotrexate) achieved remission (according to DAS 28 criteria, the main goal of therapy for this currently incurable disease1. This result is extremely important since RA is a long-term disabling disease and existing drugs provide little hope of achieving remission; as such, new treatment options for RA are urgently needed. William M. Burns, Head of Pharma, Roche: "These latest studies are encouraging news for patients suffering from the devastating effects of RA. We believe that "Actemra, the first and only biologic to demonstrate superiority over current standard of care for RA, will provide relief to many patients and offers a greater chance of achieving early and long-lasting remission."
?MODERN RHEUMATOLOGY No. 3'08
Actemra is the first and only biologic to demonstrate superiority over current standard of care for rheumatoid arthritis.
A new drug for the treatment of rheumatoid arthritis (RA) - Actemra (tocilizumab) - has demonstrated superiority over the existing standard of therapy (methotrexate): after 6 months of taking the drug, there is a more significant reduction in the severity of symptoms of the disease (swelling and tenderness of the joints) in patients suffering from RA1. Moreover, when using Actemra, approximately 3 times more patients (compared to methotrexate) achieved remission (according to DAS 28 criteria <2.6)2 - the main goal of therapy for this currently incurable disease1. This result is extremely important because RA is a long-term disabling disease and existing medications offer little hope of achieving remission; essentially,
New treatment options for RA are urgently needed.
William M. Burns, Head of Pharma, Roche, said: “These latest studies provide encouraging news for patients suffering from the devastating effects of RA. We believe Actemra, the first and only biologic to demonstrate superiority over current standard of care for RA, will provide relief to many patients. "In addition, Actemra offers a greater chance of achieving early and long-lasting remission."
The AMBITION trial, the first results of which were presented at the European League Against Rheumatism (EULAR) Congress in June 2008, was undertaken to evaluate the efficacy and safety of Actemra (at a dose of 8 mg/kg) compared with methotrexate in patients with active RA. . The study showed3 that significantly more patients achieved ACR 20 efficacy criteria after 24 weeks of treatment1 when treated with Actemra than when treated with methotrexate (70% vs. 53%). Other biologics do not demonstrate superiority over methotrexate in this important clinical parameter. In addition, when treated with Actemra monotherapy, remission was achieved approximately 3 times more often (34% versus 12% of cases) than in patients receiving methotrexate alone1. It should be noted that patients enrolled in the AMBITION trial had shorter disease duration than patients in previous studies using Actemra. Most patients were not previously treated with methotrexate or any disease-modifying antirheumatic drugs (DMARDs)1.
“We were very encouraged by the results of the AMBITION trial, which showed for the first time that therapy with a single biologic is superior to methotrexate after 6 months,” said Graham Jones, AMBITION Principal Investigator and Professor at the University of Tasmania in Hobart, Australia. “Overall, the presented results demonstrate the effectiveness and safety of Actemra in the treatment of RA, a disease that significantly affects the lives of patients.”
RADIATE trial demonstrates Actemra's effectiveness in difficult-to-treat patients
Data from this study were also presented at the EULAR Congress and published online in the Annals of Rheumatic Diseases. According to the results of the study, Ak-Temra demonstrates effectiveness in difficult-to-treat patients with inadequate effectiveness or intolerance to previous therapy with TNF-a4 blockers. 30% of patients receiving Actemra in combination with methotrexate achieved disease remission (DAS 28 <2.6); for comparison: of those receiving only methotrexate - 1.6% of patients4. The study also showed that significantly more patients treated with Actemra had reduced symptoms.
incidence of disease after treatment for 24 weeks (according to ACR 20 criteria: 50% versus 10%)4. The data obtained are very important, since the fact that 12-18% of patients included in the study had not previously responded to therapy with 3 or more TNF-a4 blockers left very little reason to assume that the severity of the symptoms of the disease in these patients would decrease with the further administration of existing drugs.
Presenting the data, Paul Emery, RADIATE Principal Investigator and Professor at the University of Leeds, UK, said: “The results of this study are promising for patients with RA who need a variety of treatment options, particularly if they are not achieving adequate symptom relief with using TNF a blockers."
Data from the AMBITION and RADIATE studies correlate with previous studies in which approximately 1/3 of patients achieved remission regardless of disease duration or prior therapy5. More than 4,000 RA patients from 41 countries, including the United States, Europe and Russia, have been enrolled in Actemra's clinical development program, one of the largest phase III clinical trials programs ever conducted for a biologic.
The AMBITION (Actemra versus Methotrexate double-Blind Investigative Trial In mONotherapy) study is a double-blind, placebo-controlled, phase III trial of 673 patients designed to evaluate the efficacy and safety of Actemra (at a dose of 8 mg/kg) compared with methotrexate in patients with active moderate or severe RA; Among the patients there was a significant proportion of people with an early stage of the disease. The primary efficacy criterion of the study was the demonstration of the superiority of Actemra over methotrexate according to ACR 20 criteria after 24 weeks of therapy. The study was conducted at 252 research sites in 18 countries. In the AMBITION 70 study; 44 and 28% of patients receiving Actemra monotherapy (at a dose of 8 mg/kg) achieved ACR 20, ACR 50 and ACR 70 criteria, respectively; among those receiving only methotrexate - 53; 34 and 15%1. Disease remission (DAS 28 <2.6) was demonstrated in 34% of patients treated with Actemra, compared with 12% of patients in the control group1.
MODERN RHEUMATOLOGY No. 308
The RADIATE (Research on Actemra Determining effIcacy after Anti-TNF Failures) study is a phase III, double-blind, placebo-controlled study evaluating the efficacy and safety of Actemra (at doses of 8 or 4 mg/kg) in combination with methotrexate in patients with moderate to severe RA. who have previously experienced inadequate efficacy or intolerance to prior therapy with at least 1 TNF-a blocker. Traditionally, such patients have a more refractory course of the disease, which is significantly less responsive to treatment. The study included 499 patients randomized into 3 groups. The study was conducted at 128 research sites in 13 countries. Patients received either Actemra 8 or 4 mg/kg or placebo in addition to 10–25 mg methotrexate weekly.
In the RADIATE 50 study; 29 and 12% of patients treated with Actemra (at a dose of 8 mg/kg) in combination with methotrexate achieved efficacy criteria of ACR 20, ACR 50 and ACR 70, respectively (the same rates for patients receiving weekly methotrexate alone were 10; 4 and 1%4. Actemra in combination with methotrexate demonstrated a significant clinical effect even in those patients who had previously received 3 TNF-blockers without effect. Moreover, remission (DAS 28 < 2.6) was achieved in 30% of patients receiving Actemra (in the control group - in 1.6% of patients)4.
Actemra is the result of scientific research by Chugai, part of the Roche group of companies. Actemra is the first humanized monoclonal antibody against interleukin 6 (IL 6) receptors. To evaluate the clinical effectiveness of the drug, an extensive research program was developed, including 5 phase III clinical studies. All of these studies successfully met their primary efficacy criteria. Registration of Actemra in the United States and European Union countries is expected in the near future. In Japan, Actemra appeared on the pharmaceutical market in 2005 as a drug from Chugai for the treatment of Castleman's disease. In April 2008, Actemra was approved in Japan for use in RA, juvenile idiopathic arthritis, and systemic-onset juvenile idiopathic arthritis.
Actemra was generally well tolerated by patients: the overall safety profile of the drug was consistent across all global clinical studies. The most frequently reported adverse events were upper respiratory tract infections,
nasopharyngitis, headache and arterial hypertension. As with other biologic drugs used to treat RA, cases of serious infections and hypersensitivity reactions, including several cases of anaphylaxis, have been reported in patients receiving Actemra. In some patients, the activity of liver transaminases (ALT and AST) increased; this increase was generally considered minor, transient, and not associated with liver damage or decreased liver function.
The Roche group of companies, headquartered in Basel (Switzerland), occupies a leading position among corporations operating in the healthcare sector and focused on its own research into the development of medicines and diagnostics. As a leading global biotechnology company and developer of innovative products for the early detection, prevention, diagnosis and treatment of diseases, the Roche Group makes important contributions to improving the health and quality of life of people across a wide range of areas. The Roche group of companies is a world leader in the production of in vitro diagnostics, drugs for the treatment of cancer and concomitant therapies for organ and tissue transplantation; occupies a leading position in the antiviral drugs market. The Roche Group is also active in other important therapeutic areas (autoimmune and inflammatory diseases, metabolic disorders and diseases of the central nervous system). In 2007, sales of the Pharma division amounted to 36.8 billion Swiss francs, and the Diagnostics division amounted to 9.6 billion francs. Roche has research collaborations and strategic partnerships with various companies, including being a major shareholder in Genentech and Chugai. Its investments in research and development in 2007 amounted to 8 billion Swiss francs. The Roche group of companies employs about 79 thousand people around the world. Additional information about the Roche group of companies can be found on the Internet at: www.roche.com
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More detailed information:
• Roche and autoimmune diseases: www.roche.com/med_events_mb1106
Jones G. et al. Tocilizumab monotherapy is superior to methotrexate monotherapy in reducing disease activity in patients with rheumatoid arthritis: The AMBITION study. Presented at EULAR, 13 June 2008.
2Disease Activity Index (DAS 28) is a composite index measuring disease activity in patients with RA. It includes information on 28 painful and swollen joints (range 0-28), erythrocyte sedimentation rate and overall health score using VAS. The level of disease activity is interpreted as low (DAS 28<3.2), moderate (3.2 5.1). DAS 28<2.6 refers to remission according to the American Rheumatism Association (ARA) criteria.
'The ACR criteria are a standard assessment used to measure patient response to treatment with antirheumatic drugs, developed by the American College of Rheumatology (ACR). The patient must have a certain percentage reduction in the corresponding symptoms of the disease. For example, reduction levels are 20; 50 or 70% (percentage reduction in RA symptoms) is reported as an ACR 20, ACR 50, or ACR 70. An ACR 70 response is exceptional among current treatment regimens and represents a significant improvement in the patient's condition.
4Emery P. et al. Tocilizumab significantly improves disease outcomes in patients with rheumatoid arthritis whose anti-TNF therapy failed: The RADIATE study. Presented at EULAR, 13 June 2008.
5Disease remission (DAS 28<2.6) was achieved in every 3rd patient treated with Actemra in combination with DMARDS in the TOWARD (Tocilizumab in combination With traditional DMARD therapy) study, presented at the Congress of the American Society of Rheumatology - ACR 2007; similar results were also obtained in the OPTION (TOcilizumab Pivotal Trial in Methotrexate Inadequate responders) study, presented at the Congress of the European League Against Rheumatism. EULAR, 2007.
The description is valid on 11.01.2016
1 ml of concentrate, calculated for the preparation of infusion solutions, contains 20 mg of tocilizumab and auxiliary compounds: sucrose, polysorbate 80, dodecahydrate and sodium hydrogen phosphate dihydrate, water for injection.
The drug Actemra is sold in bottles of 4, 10 or 20 ml. One cardboard box usually contains 4 or 1 bottle. The concentrate itself is an opalescent colorless liquid.
Actemra has an immunosuppressive effect.
Tocilizumab is a recombinant humanized monoclonal antibody to the Interleukin 6 (abbr. IL-6 ) receptors in the human body and belongs to the immunoglobulin the IgG1 isotype . The mechanism of action is based on selective binding and inhibition of both soluble and membrane receptors for IL-6 . Interleukin 6 is an indicator of the immune response, it is a multifunctional cytokine produced by various types of cells that take part in paracrine regulation, pathological processes and systemic physiological reactions, for example, activation of T-lymphocytes, stimulation of Ig production, hematopoiesis, proteins of the acute phase of inflammation (stress -proteins) in the liver. Since Interleukin 6 of tocilizumab , for example, on the anti-infective or anti-tumor defense of the body should not be excluded
In rheumatoid arthritis (RA), the therapeutic effect is observed after 0.5 years when using a dose of 8 mg/kg and occurs in relation to all ACR criteria (American College of Rheumatology) , including the number of swollen joints, pain assessment, general improvement, HAQ . C-reactive protein assay. The response to treatment occurs quickly - from the second week and intensifies throughout the entire therapy, lasting more than 1.5 years.
Studies have shown that a dose of tocilizumab 8 mg/kg, when used alone and in combination with DMARDs + Methotrexate , gives a statistically significant (p <0.0001) increase in hemoglobin at week 24 (most pronounced in patients suffering from chronic anemia accompanying RA ) .
After administration of the drug, there is a rapid decrease in acute phase parameters, including C-reactive protein, ESR , serum amyloid A, and the number of platelets decreases within normal limits.
Actemra is prescribed for moderate to severe rheumatoid arthritis Methotrexate , as well as other key anti-inflammatory drugs.
A dose of 8 mg/kg should be administered intravenously over 60 minutes, no more than once every four weeks.
It is recommended to dilute the drug Actemra to 100 ml using a sterile 0.9% sodium chloride , taking into account aseptic conditions.
Despite the fact that the prepared solution is physically and chemically stable for the first 24 hours (the temperature should not exceed + 2–8 °C), from a microbiological point of view it must be administered immediately. Otherwise, the consequences become the responsibility of the user.
A case of unintentional drug overdose has been recorded. A patient with multiple myeloma used a dose of 40 mg/kg and did not experience any adverse reactions. Healthy volunteers who agreed to receive a single dose of 28 mg/kg Actemra experienced the development of neutropenia , leading to dose reduction.
Actemra must be available with a prescription.
Darkness, 2–8 ° Celsius (do not freeze!).
Children should not have access to vials of Actemra concentrate.
Storage in original packaging is possible for 2.5 years.
There are no data available on the safety and effectiveness of tocilizumab in children.
It is generally accepted that Interleukin 6 does not play a decisive role in intrauterine development or immune regulation of the maternal and fetal system, however, a relationship with the use of tocilizumab cannot be excluded.
Finding reviews is quite difficult. Many people are interested in this drug, and they are trying to get it. Actemra was mentioned on central television as the latest progressive remedy for rheumatoid arthritis . This is a fairly expensive new generation drug, on which many have serious hopes.
It is recommended to buy Actemra 4 ml at a price of no more than 17,200 rubles.
Rheumatoid arthritis is not easy to cure. As a matter of fact, it is possible to achieve a complete cure of this disease in very rare cases, since most of the drugs used in our time have only a symptomatic effect. Such drugs eliminate the manifestations of the disease (pain, inflammation of the joints), but do not affect its causes.
For example, the same “classical” non-steroidal anti-inflammatory drugs are used as first aid for joint pain. Although NSAIDs can significantly make a patient’s life easier, it is impossible to cure rheumatoid arthritis with non-steroidal anti-inflammatory drugs.
In addition to NSAIDs, to provide quick help to those suffering from rheumatoid arthritis, many doctors, especially foreign ones, without hesitation, prescribe anti-inflammatory corticosteroid hormones (prednisolone, methylpred, hydrocortisone, etc.).
The use of such hormones almost always leads to a clear improvement in the patient's condition. Joint pain immediately decreases, morning stiffness, weakness and chills disappear. Naturally, for such a quick result, any patient is willing to pay money, and considerable money at that, which is the main incentive of Western medicine.
Unfortunately, patients taking corticosteroid hormones are often unaware that they are receiving a fairly powerful blow to all body systems. After all, corticosteroids are stress hormones. And as long as the patient takes such hormones, he feels good. But as soon as they are canceled or the dose is reduced, the disease will literally attack the person with double or triple force.
You may ask: maybe then it’s worth not canceling hormones, but continuing to take them constantly? No, this is not an option. The fact that over time corticosteroids no longer relieve pain as well as at the beginning of their use is not so bad. The worst thing is that the side effects from their use gradually “accumulate”. And there are many such side effects - corticosteroids contribute to the development of diabetes mellitus, increased blood pressure, and increased body weight. In addition, such hormones reduce immunity, provoke the appearance of stomach ulcers and lead to edema.
As a result, sooner or later there comes a time when the patient is forced to stop taking hormones. But this is not so easy to do. The body can no longer cope without the supply of corticosteroids from the outside, and a rapid reduction in their dose leads to a sharp deterioration in well-being and exacerbation of joint pain. Therefore, the doses of hormones consumed must be reduced gradually, and their final withdrawal is delayed for several months. But even with a gradual reduction in the dose of hormones, the process is rarely painless for the body.
So, before prescribing hormone therapy to a patient, the doctor must weigh three times whether such treatment will cause more harm or benefit.
But if neither hormonal nor steroidal anti-inflammatory drugs for rheumatoid arthritis can give a long-term positive effect, then how should the patient be treated?
The main treatment for rheumatoid arthritis are the so-called basic drugs. They influence the soil that gives rise to the disease, its “base”. These remedies are used with an eye to the future, counting on their ability to influence the causes of the disease and interrupt its development. But you need to keep in mind that, unlike hormones and NSAIDs, basic drugs do not provide an immediate positive effect, that is, they do not eliminate the symptoms of the disease in the first days and weeks of using the drugs. As a rule, they are able to act no earlier than in a month - this is a significant drawback of basic drugs.
Currently, five groups of drugs are most often used as basic therapy: gold salts, antimalarial drugs, the antimicrobial drug sulfasalazine, immunosuppressive drugs and penicillamine.
Gold preparations (krizanol, auranofin) are the most popular group of basic drugs among rheumatologists for the treatment of rheumatoid arthritis. Gold preparations bring significant relief to approximately 70% of patients, but a third of patients may experience complications during treatment: allergic skin rash, inflammation of the oral mucosa, suppression of hematopoiesis and deterioration in kidney function.
Such phenomena most often make themselves felt in the first months of treatment. Therefore, in order not to miss the so-called “golden” complications, the patient’s blood and urine should be examined at least once a month for six months and the condition of his skin and oral mucosa should be constantly monitored. At the first sign of complications, treatment with gold preparations should be stopped. And we must remember that gold preparations are contraindicated for patients suffering from diabetes, kidney disease and blood diseases.
The first positive changes after starting treatment can be seen within a month, and the best results should be expected after six months to a year. It is believed that it is achieved after the patient receives a dose of medicines containing a total of one gram of pure gold. In previous years, treatment was stopped when this equivalent was reached. However, in some patients, after some time, the disease worsened again, and repeated administration of gold preparations no longer brought relief. Alas, only one course of “golden” treatment is effective. Repeating it after a break does not give the patient anything. That is why, in our time, the initial use of “golden drugs” is continued indefinitely, literally for years - unless, of course, complications occur.
D-penicillamine (cuprenil) is usually prescribed in cases where gold therapy does not bring relief to the patient or when gold preparations have to be discontinued due to adverse reactions. However, D-penicillamine, which is not inferior in effectiveness to gold preparations, is no less toxic and causes complications much more often. They usually appear in the first two months of using the drug and, fortunately, quickly disappear after discontinuation of the drug.
Complications may include skin rash, disorders of the stomach and intestines, inflammation of the kidneys, jaundice resulting from stagnation of bile, as well as changes in blood composition. Therefore, when using D-penicillamine as a “basic” agent, the patient must initially undergo a blood test once a week and a urine test once every two weeks. It is important to consider that D-penicillamine is contraindicated in pregnant women and those patients who have blood and kidney diseases.
You may ask: if D-penicillamine is such a “heavy” drug, why do doctors continue to prescribe it? The fact is that sometimes other basic drugs turn out to be ineffective or they have to be canceled due to side effects, and the rheumatologist simply has no choice. You cannot leave a patient without help when the doctor has a strong drug in his arsenal, even if the risk of side effects is quite high. In the end, when the first signs of complications caused by taking D-penicillamine appear, you can stop this drug and quickly eliminate the unpleasant phenomena. In addition, there are cases when D-penicillamine should be prescribed first, for example, if arthritis has caused a rheumatoid complication in the lungs or heart.
If the drug is well tolerated and there are no contraindications, treatment with D-penicillamine is continued for up to 3-5 years. Then you can take a break for 1-2 years and continue treatment with D-penicillamine again for another 3-4 years. Fortunately, unlike gold preparations, this medicine does not lose its effectiveness even after a break in treatment. Although it must be borne in mind that 10% of patients taking D-penicillamine and experiencing an improvement in their condition may then experience an exacerbation of the disease - the so-called phenomenon of “secondary ineffectiveness” appears.
Sulfasalasia (salazopyridazine) is an antimicrobial drug, somewhat less effective than gold drugs, but successfully competes with D-penicillamine, especially since it is much better tolerated than these drugs. Side effects from sulfasalazine develop in only 10-20% of patients, and these complications are never severe. They manifest themselves mainly as stool disorders and skin rashes.
The only thing that detracts from the advantages of the drug is the slow development of its therapeutic effect. Improvement during treatment with sulfasalazine is usually observed only after three months of therapy, and the “peak form” is reached after six months, after which treatment with sulfasalazine is completed.
The antimalarial drugs delagil and plaquenil were once used by infectious disease specialists to treat dengue fever (malaria). However, in the 20th century, rheumatologists also paid attention to them. They noticed that with very long-term use, delagil and plaquenil can influence the activity of the rheumatoid process.
Although the effectiveness of these drugs is not very high and they act slowly, we are forced to use them to this day, since we feel a relative shortage of anti-rheumatoid drugs. After all, sometimes situations arise when other basic remedies are tried unsuccessfully and canceled due to ineffectiveness or severe side effects. Then it is necessary to use delagil and plaquenil, which are weak but still have a specific anti-arthritic effect.
Well, besides, one cannot help but mention the force of inertia, which often prompts rheumatologists even today to recommend antimalarial drugs. Apparently, the outdated and once established rule is working, which prescribed that patients with rheumatoid arthritis should be prescribed Delagil or Plaquenil first, then gold or D-lenicillamine, and, inevitably, hormones.
The concept is clearly outdated, and was controversial before. From my point of view, with actively progressing rheumatoid arthritis, waiting for Delagil or Plaquenil to work (and this is a period of six to nine months), without even trying to use stronger basic drugs, is simply criminal. When it is known that gold salts or immunosuppressants will take effect within a month or two, it is, to put it mildly, absurd to condemn the patient to long suffering while waiting for the therapeutic effect of antimalarials. Nevertheless, some rheumatologists are still guided by outdated textbooks and primarily prescribe delagil or plaquenil to patients.
According to the majority of leading modern rheumatologists, basic therapy should begin with antimalarial drugs only in cases where rheumatoid arthritis is very mild and there is no need for stronger drugs that have a better therapeutic effect, but can provoke numerous side effects. In contrast, antimalarial drugs are practically harmless. Only in rare cases, with long-term use, delagil or plaquenil can cause the development of eye pathology and a decrease in visual acuity, and even less often provoke nausea, tinnitus, headache and skin rash. However, all of the above phenomena, except eye pathology, quickly disappear after discontinuation of the medication. And in order not to “miss” eye problems, it is enough to follow certain precautions.
So, once every three months, a patient who has been taking Delagil or Plaquenil for a long time should be seen by an ophthalmologist. This doctor measures the patient's vision and makes a determination about the possibility of further use of antimalarial drugs. If the patient's lateral vision decreases, delagil or plaquenil should be discontinued. If the breadth of vision does not change, treatment continues.
Antimalarial drugs have been taken for several years.
Cytostatic drugs, or so-called immunosuppressants (methotrexant, azathioprine, cyclophosphamide, chlorobutin, leukeran), were borrowed by rheumatologists from oncologists. Cytostatics are used in oncology to suppress the immune system and inhibit cell division, including cancer cells. Moreover, these drugs are prescribed to cancer patients in huge doses, which leads to a large number of complications. In this regard, both doctors and patients are very wary of the use of cytostatics, fearing severe side effects.
However, when it comes to the use of these drugs in the treatment of arthritis, the danger is clearly exaggerated, because in arthrology, cytostatics are used in significantly lower doses than in oncology (doses are approximately 3-10 times less!). Such small amounts of immunosuppressive drugs rarely cause side effects, but the therapeutic effect is often significant. The use of cytostatics helps at least 70% of patients, and the greatest benefit comes from the drugs to those suffering from a rapidly progressing severe form of rheumatoid arthritis.
Side effects are possible in 15-20% of patients and are rarely severe. Most often these are allergic rashes, a sensation of “goosebumps” on the skin, stool upset and moderate urination problems. All these manifestations usually disappear immediately after stopping the drugs.
However, to avoid complications, it is necessary to monitor the condition of the patient taking immunosuppressants. Once a month you need to examine your urine, and most importantly, do a blood test taken from your finger once every two weeks in order to notice in time a possible inhibition of hematopoiesis.
If everything is in order and the patient easily tolerates cytostatic therapy, you can expect a clear improvement in well-being within 2-4 weeks after the start of treatment.
So, there are five groups of basic drugs to combat rheumatoid arthritis. We have just reviewed their advantages and disadvantages. But which medicine is preferable in each specific case? Only your treating rheumatologist can answer this question. Only he knows (in any case, he should know) when and what basic remedy should be used in your case. Although the disadvantage of basic drugs is precisely that it is difficult to guess with one hundred percent probability whether the medicine will have a therapeutic effect. Only after a month or two of using the drug can you get an answer to this question. And if the drug does not work, then you have to change it and again wait a month or two for the result.
Thus, it sometimes takes 4-6 months to select basic therapy. The period is, of course, extremely long for a sick person, but we have to accept it - we have no other choice. You can, however, try to improve the patient's condition for this period by means of local effects on the joints. For this purpose, dimexide applications, laser therapy, cryotherapy and intra-articular injections of corticosteroid hormones are used.
Applications with dimexide are applied to the most inflamed and painful joints. In rheumatoid patients, improvement is observed after 6-7 days of therapy with dimexide and becomes even more noticeable after a two-week series of applications. In total, the positive effect is expressed in 80% of patients.
Intra-articular administration of corticosteroid hormones (kenalog, hydrocortisone, dydrospan, flosterone) helps the patient survive a period of particularly acute inflammation of individual joints. When administered intra-articularly, hormones quite quickly relieve pain and reduce inflammation of the joint, but usually the therapeutic effect lasts only two to three weeks. Then the inflammation begins to gradually increase again.
As with arthrosis, it is advisable to carry out no more than two or three injections of corticosteroids into each joint. In addition, you need to remember that you cannot get too carried away with hormone injections and do them too often - otherwise the hormones will begin to have a negative effect on the entire body. Therefore, the intervals between such procedures should be at least 7-10 days. But, of course, intra-articular injections can significantly make life easier for the patient, even in particularly severe cases of rheumatoid arthritis.
Diseases of the lower extremities, more details...
IT IS IMPORTANT TO KNOW! The only remedy for JOINT PAIN, arthritis, arthrosis, osteochondrosis and other diseases of the musculoskeletal system, recommended by doctors! Read more.
Until now, no specific remedy has been found that could relieve a person of joint pain once and for all. Today no one knows how to defeat rheumatoid arthritis completely. Therefore, if you meet a person who claims that he can remove such a diagnosis, he is definitely a scammer. However, treatment of rheumatoid arthritis with new generation drugs and modern medical technologies gives hope for a long and fulfilling life, albeit with certain limitations.
The fact is that rheumatoid arthritis is a systemic disease that affects the entire body, and not just the joints, and it is associated with autoaggression of the human immune system, which is why the doctor prescribes so many medications and prescribes so many procedures. It is worth being patient if you want to stay healthy. The complex treatment regimen for rheumatoid arthritis is complex; it must be compiled only by a qualified rheumatologist. Self-medication is unacceptable and can lead to disability! Modern
Let's take a closer look at modern methods of treating rheumatoid arthritis.
Actemra or Tocilizumab is a concentrated drug from which a solution for droppers is prepared. It is a clear or slightly yellowish liquid.
The main element is tocilizumab, which is supplemented with sucrose, polysorbate and sodium dihydroate. Available in glass bottles of 4, 10, 20 ml.
The drug is used in the treatment of rheumatoid arthritis to treat adult patients. It is used both in monotherapy and in combination with other drugs. In children over two years of age, when juvenile idiopathic arthritis is detected, Actemra is also included in the treatment complex.
The medicine is produced in Japan by the pharmaceutical company Chugai Pharma Manufacturing Co. Ltd.
The drug belongs to the group of immunosuppressants.
The main substance of the drug suppresses IL-6 receptors, which are involved in the pathogenesis of inflammatory diseases and tumor formation. Clinical trials of the drug on patients with rheumatoid arthritis showed that the effect of Actemr was felt after 14 days, during the course it intensified and persisted for a year and a half.
For the therapeutic course, a dose of 8 mg/kg was used. Tocilizumab was much more effective than placebo + DMARDs in terms of providing a positive effect on the physical and mental health parameters of patients.
The level of hemoglobin in the blood increased and remained normal for several months, and the levels of reactive protein and platelets decreased.
The rate of elimination of tocilizumab depends on the drug concentration upon administration. At a dose of 4 mg/kg once every 4 weeks, it is excreted after 11 days, at a dose of 8 mg/kg once every 4 weeks - after 13 days.
Indications for use of the drug Actemra:
About rheumatoid arthritis seriously:
The properties of the drug allow it to be used for various diseases and painful conditions. The medicine is used in dentistry, in the treatment of headaches, muscle and joint pain. The drug relieves inflammatory symptoms well and reduces joint swelling in rheumatoid arthritis.
For chronic diseases and special conditions of the patient, treatment should be monitored by the attending physician, he selects the dosage and frequency of treatment courses.
The doctor and the patient must make a decision on the use of Actemra in a given situation, since any potent medicine also has contraindications:
In addition to an allergy to the drug, other body reactions may occur. Which organs may react negatively to taking Actemra:
More serious complications from the urinary and endocrine systems are less common. Failures in metabolic processes are possible. The effect of the drug on the patient’s body should be monitored by a doctor.
There is no extensive data on cases of overdose, but the available information shows that a slight excess of the dose of the drug does not have a negative effect on the patient’s body.
To avoid side effects associated with overdose, you must carefully read the instructions and adhere to the recommendations given therein.
The usual therapeutic course involves intravenous administration of a solution of the drug once a month at 8 mg/kg. This procedure is carried out in a medical facility under the supervision of a doctor. The drug administration time is at least 1 hour.
A dose of Actemra concentrate is diluted in 100 ml of sodium chloride. It is calculated individually for each patient, but cannot be more than 800 mg. The concentrate is taken at the rate of 0.4 mg/1kg.
Dilution of the composition requires caution and skill. To prevent the solution from foaming, the bottle into which sodium chloride is added to Actemra is turned over. The solution for administration should be transparent without any impurities.
The use of the drug during pregnancy and lactation has been little studied. When testing the medicine on primates, it was revealed that a high concentration of the solution entails the threat of miscarriage in the early stages or the death of the embryo. Excretion in breast milk is unlikely.
Doctors do not recommend using the drug to treat children under 2 years of age due to the large number of side effects.
It is difficult to digest even by an adult body. Therefore, for the treatment of children, the medication is used in extreme cases.
Cases where special attention is required when treated with Actemra:
The use of the drug does not affect the ability to normally drive a car or other automatic and mechanical devices and devices.
The potent drug Actemra requires special care during use. If the patient “caught” a virus or infection, treatment is interrupted until the patient recovers completely.
The drug itself can stimulate the development of an infectious disease in patients with diabetes and some other diseases. These patients should monitor their condition during treatment and notify the doctor, who can adjust the therapy.
Difficulties in using the drug may arise in patients with ulcerative symptoms in the gastrointestinal tract. If there is a suspicion of such manifestations, it is necessary to carry out the necessary examinations in advance, including laboratory tests.
The drug Actemra is compatible with Methotrexate and is used in complex therapy. The effect of the drug on other biological DMARDs has not been studied.
It can be used together:
The drug Actemra has not yet been studied enough, so doctors’ statements are very cautious, but patients willingly share their impressions of the treatment, and numerous reviews can be found on the Internet.
I have suffered from rheumatoid arthritis for a long time. She was treated with different medications, but Actemra turned out to be the most effective. True, there are side effects in the form of shortness of breath and itching, but this, compared to unbearable pain in the joints, is nothing. I undergo treatment once a year.
I would like the government to help those who urgently need it to purchase medicine.
The complex, expensive drug Actemra produces visible, tangible results. The treatment is long-term – more than six months. You cannot prescribe it yourself; it has many contraindications.
The attending physician must select the dose and duration of the course depending on the severity of the disease. This medicine helped me get rid of severe pain in my spine.
Those who are planning to be treated with Tocilizumab can additionally read information about it on the Internet, reviews of patients and doctors about this medicine are published there.
Acterma is a very expensive drug and not everyone can buy it, the price of a concentrate of 20 mg/ml for 80 mg/4 ml No. 1 is 6500-7000 rubles, and 200 mg/10 ml No. 1fl costs more than 15,000 rubles.
The extract is stored for 2.5 years at a temperature of 2-8C. It cannot be frozen. It is prohibited to use after the expiration date.
The solution prepared for intravenous administration is suitable for use throughout the day at temperatures up to 30C. But, in order for it not to lose its activity, it is better to use it immediately after dilution.
Finding the drug in the provinces is not easy, and it costs more there than in Moscow. You can order online with delivery, it will be cheaper.
If Actemra is not available in the pharmacy or the price is unaffordable (and it must be said that the medicine is very expensive), then the attending physician may advise purchasing its analogues based on the effect they have on the body:
Other drugs with similar effects: