Question: Should arthritis patients fear the side effects of Enbrel, Remicade, and Humira?
Arthritis patients are sometimes afraid of the biologic response modifiers known as anti-TNF drugs. The side-effects can be very serious (serious infection, lymphoma etc.), so their fears are not illogical. What is the benefit vs. risk for TNF blockers? If your condition is out of control, the risk may be obviously necessary. Are the TNF blockers ever a first-line defense though?
Answer: The TNF(tumor necrosis inhibitor) blockers are considered biological DMARDS and include Enbrel (Etanercept), Humira (Adalimumab) and Remicade (Infliximab). They have a very good benefit/risk ratio. In other words, while potentially serious side effects may develop, they are not common and up 70% of patients may see significant clinical benefit.
The class of drugs has been studied in patients for almost 9 years and have been on the market for over 6 years. Two major concerns with these drugs include the risk of serious infection or Lymphoma. Rheumatoid arthritis patients have an increased risk of developing these two problems compared to the general population. In fact, patients who have the most severe cases of RA are more likely to develop lymphoma than those with milder disease, so it will be of interest to see over time whether treatment with these medications to control disease activity may actually decrease the incidence of this problem. There is evidence that the drugs increase the risk of developing unusual infections like tuberculosis (it is recommended that all patients be screened with a skin test to check for prior exposure to TB before beginning therapy with a TNF blocker). Other serious infections have also been reported since the drug has been on the market.
Be extra cautious about taking these medications if you are an insulin dependent diabetic or have another reason to be at increased risk for infection, recurring infections or open wounds/sores. Many rheumatoid patients may do very well on the traditional DMARDS such as Plaquenil (hydroxychloroquine), Azulfidine (sulfasalazine) or Rheumatrex (methotrexate) and may never need to take a TNF blocker. In patients who have significant disease and have reasons they should not take methotrexate (eg. will not avoid alcohol), TNF blockers can be used as a first line treatment.
Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of Anti-TNF Blockers. The book is a must-have for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book.
Also read:
Enbrel, Remicade, and Humira - How are the drugs similar and different?
Patients are often advised to weigh the benefit and risk of any medication, including TNF blockers Enbrel, Remicade, and Humira. What similarities and differences are there between the three drugs?
Take the quiz:
TNF Blockers (Enbrel, Remicade, Humira) - Test Your Knowledge
New arthritis drug classes have been developed and approved for marketing since 1998. How much do you know about arthritis drugs Enbrel, Remicade, and Humira?
