(Press-News.org) Treatment with a biological agent was not superior to conventional treatment in terms of the effect on work loss over 21 months in patients with early rheumatoid arthritis (RA) who responded insufficiently to methotrexate, according to a report published by JAMA Internal Medicine, a JAMA Network publication.
The introduction of biological tumor necrosis factor inhibitors has improved the treatment of RA but at a substantial cost, according to the study background.
From a randomized clinical trial, Jonas K. Eriksson, M.Sc., of the Karolinska Institutet, Sweden, and colleagues measured monthly sick leave and disability pension days in patients who did not achieve low disease activity after three to four months of methotrexate therapy. The patients were divided into groups to receive additional biological treatment with infliximab or conventional combination treatment with sulfasalazine plus hydroxychloroquine. Of 204 eligible patients, 105 were assigned to biological and 99 to conventional treatment.
The baseline average work loss was 17 days per month in both groups. The average changes in work loss at 21 months were -4.9 days per month in the biological and -6.2 days per month in the conventional treatment group, according to the study results.
"Our analysis showed that early and aggressive treatment in methotrexate-resistant patients not only stops the trend of increasing work loss days, as in patients with mainly established RA, but partly reverses it. However, we did not find any difference between treatment arms, indicating that the significantly improved disease control associated with infliximab treatment over a one-year period and the better radiological results after two years did not translate into less work loss," the study concludes. "The substantially higher cost of infliximab relative to conventional treatment needs to be weighed against the greater incidence of short-term adverse events leading to discontinuation of conventional treatment."
(JAMA Intern Med. Published online July 1, 2013. doi:10.1001/jamainternmed.2013.7801. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Authors made conflict of interest disclosures. The study was funded by the Swedish Rheumatism Association and Schering-Plough/Merck Sharp and Dohme. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Not Better but Quite Good
In an invited commentary, Edward Yelin, Ph.D., University of California, San Francisco, writes: "In this issue of JAMA Internal Medicine, Eriksson and colleagues have taken advantage of a well-done clinical trial in patients with early RA, comparing conventional [disease-modifying antirheumatic drugs] DMARD treatment with or without the addition of biological agents, to study the effects on work loss."
"In the real-world situation of sequential use of combinations, first excluding and only after that including biological agents, the outcome might not match that achieved after simultaneous randomization, but the fine study done by Eriksson and colleagues indicates that it may be good enough," Yelin concludes.
(JAMA Intern Med. Published online July 1, 2013. doi:10.1001/jamainternmed.2013.7812. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: This study was supported by a grant from the National Institute of Arthritis and Muscoskeletal and Skin Diseases. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
The effect on work loss of different treatments for rheumatoid arthritis
ELSE PRESS RELEASES FROM THIS DATE:
Exercise-induced improvements in glycemic control and type 2 diabetes
Exercise-induced improvements in glycemic control are dependent on the pre-training glycemic level, and although moderate-intensity aerobic exercise can improve glycemic control, individuals with ambient hyperglycemia (high blood glucose) are more likely to be nonresponders, according to a research letter by Thomas P. J. Solomon, Ph.D. of the Centre of Inflammation and Metabolism, Copenhagen, Denmark, and colleagues. A total of 105 older (average age 61 years), overweight or obese individuals with impaired glucose tolerance or type 2 diabetes mellitus (T2DM) participated ...
Vital sign collection based on patient risk for clinical deterioration
Nighttime frequency of vital signs monitoring for low-risk medical inpatients might be reduced, according to a research letter by Jordan C. Yoder, B.A. and colleagues at the University of Chicago. Overnight vital signs are collected frequently among hospitalized patients regardless of their risk of clinical deterioration and these vital checks may have negative effects on low-risk patients such as patient distress and sleep deprivation, according to the study. In total, 54,096 patients were included in the study, accounting for 182,828 patient-days and 1,699 adverse ...
Early childhood respiratory infections may be potential risk factor for type 1 diabetes mellitus
Respiratory infections in early childhood may be a potential risk factor for developing type 1 diabetes mellitus (T1D), according to a study published by JAMA Pediatrics, a JAMA Network publication. The incidence of T1D is increasing worldwide, although its etiology is not well understood. Infections have been discussed as an important environmental determinant, according to the study background. Andreas Beyerlein, Ph.D., from the Institute of Diabetes Research, Munich, Germany, and colleagues sought to determine whether early, short-term or cumulative exposures to ...
New generation electronic games boosts kids' physical activity at home
Most electronic games are no better than watching TV in terms of the body movement and energy expenditure involved, say the authors. Kids in developed countries spend an estimated 38 to 90 minutes a day playing these games. But what has not been clear is whether the newer generation "active" games, such as Sony PlayStation EyeToy and Move, dance mats, and Microsoft Xbox Kinect, are any better. The Australian researchers compared the impact of removing traditional electronic games, involving a game pad, from the home or replacing them with more active newer generation ...
1 in 5 UK NHS staff report bullying by colleagues
One in five UK NHS staff report bullying by colleagues, with almost half saying they have witnessed bullying, in the past six months, indicates research published in the online journal BMJ Open. Managers are the most common source of bullying, with workload pressures and organisational culture contributory factors, the study reveals. The findings are based on the responses of almost 3000 NHS staff (46% response rate) to a validated questionnaire (NAQ-R), designed to tease out exposure to negative and bullying behaviours. The 12 item General Health Questionnaire (GHQ-12) ...
Long term night shifts linked to doubling of breast cancer risk
Shift work has been suggested as a risk factor for breast cancer, but there has been some doubt about the strength of the findings, largely because of issues around the assessment of exposure and the failure to capture the diversity of shift work patterns. Several previous studies have also been confined to nurses rather than the general population. In this study, the researchers assessed whether night shifts were linked to an increased risk of breast cancer among 1134 women with breast cancer and 1179 women without the disease, but of the same age, in Vancouver, British ...
Supersense: It's a snap for crocs
Previously misunderstood multi-sensory organs in the skin of crocodylians are sensitive to touch, heat, cold, and the chemicals in their environment, finds research in BioMed Central's open access journal EvoDevo. These sensors have no equivalent in any other vertebrate. Crocodylians, the group that includes crocodiles, gharials, alligators and caimans, have particularly tough epidermal scales consisting of keratin and bony plates for added protection. On the head, these scales are unusual because they result from cracking of the hardened skin, rather than their shape ...
Treating TB: What needs to be done to improve treatment rates
People with tuberculosis (TB) in China often delay going to see a doctor for more than two weeks, finds research in BioMed Central's open access journal BMC Medicine. Reasons for this include a poor understanding of TB, increasing costs of treatment not covered by health insurance, and using traditional approaches first. Even after going to a clinic there were still delays in treatment, especially in rural areas, due to a lack of qualified medical staff. Worldwide TB remains a leading cause of death, and China has the second largest TB epidemic with the most number of ...
Study examines out-of hospital stroke policy at Chicago hospitals
Implementing an out-of hospital stroke policy in some Chicago hospitals was associated with significant improvements in emergency medical services use and increased intravenous tissue plasminogen activator (tPA) use at primary stroke centers, according to a study published by JAMA Neurology. The study evaluated the relationship between a citywide policy recommending pre-hospital triage of patients with suspected stroke to transport them to the nearest primary stroke center and use of intravenous tPA use. The therapy is used to restore blood flow through blocked arteries ...
Identifying climate impact hotspots across sectors
It identifies the Amazon region, the Mediterranean and East Africa as regions that might experience severe change in multiple sectors. The article is part of the outcome of the Intersectoral Impact Model Intercomparison Project (ISI-MIP) that will be featured in a special issue of PNAS later this year. "Overlapping impacts of climate change in different sectors have the potential to interact and thus multiply pressure on the livelihoods of people in the affected regions," says lead-author Franziska Piontek of the Potsdam Institute for Climate Impact Research. "This is ...