Treatment failure with disease-modifying antirheumatic drugs in rheumatoid arthritis patients

<p><b>INTRODUCTION</b>Rheumatoid arthritis (RA) patients taking disease-modifying antirheumatic drugs (DMARDs) may experience treatment failure due to adverse effects or a lack of efficacy/resistance. The purpose of this study was to evaluate the prescription patterns, the incidence and reasons for failure, and the time to treatment failure of DMARDs in RA patients.</p><p><b>METHODS</b>The medical records of patients visiting the Rheumatology Clinic were scrutinised retrospectively in order to extract the relevant data, including demographics, clinical and laboratory investigations and drug usage, for analysis.</p><p><b>RESULTS</b>More than 60% of the 474 eligible patients were started on a combination of DMARDs. Hydroxychloroquine (HCQ) (79.7%) and methotrexate (MTX) (55.6%) were the most common DMARDs prescribed initially. There was a significant difference in survival times among the various treatment groups (p ≤ 0.001). Adverse effect was the main reason for treatment failure of sulfasalazine (SSZ) (88.9%) and MTX (75%), while addition or substitution DMARDs was more common for those taking HCQ (72.2%). Adverse event was reported as the most significant predictor of treatment failure. The most commonly reported adverse effects were bone marrow suppression and hepatotoxicity.</p><p><b>CONCLUSION</b>A combination of DMARDs was used to initiate therapy in more than 60% of RA patients, with HCQ and MTX being prescribed most frequently. Adverse effects accounted mainly for treatment failures with MTX and SSZ, while lack of efficacy was responsible for major treatment failures with HCQ.</p>

Bird Flu: a new emerging pandemic threat and its pharmacological intervention

Bird flu is an infection caused by avian influenza viruses, which are of different types A, B and C. Type A avian influenza viruses are the most frequently associated with avian influenza epidemics and pandemics. There are 16 hemagglutinin [H1 to H16] and 9 neuraminidase types [N1 to N9] identified till date. A peculiar characteristic of influenza A viruses is their propensity for genetic change by two main processes: antigenic drift [small, gradual changes] and antigenic shift [abrupt, major change producing a novel influenza A virus subtype]. There are various modes of transmission of human influenza including inhalation, direct or indirect [fomite] contact etc., can have manifestations ranging from mild to severe or fatal disease, depend on the viral subtype causing the disease. Avian influenza A [H5N1] results in high death rate amongst infants and young children. The first outbreak of human infection by avian influenza viruses [H5N1] was observed in 1997 in Hong Kong. Since then a large number of outbreaks have been reported in different parts of the world. In fact, the spread of avian influenza H5N1 in various species including humans has lead to a current pandemic threat. Human avian influenza infections in persons at high risk of exposure can be prevented by adopting a series of protective measures, anti-viral vaccination and health monitoring. Drugs currently available for the treatment or prophylaxis of influenza infections include the adamantanes [amantadine and rimantadine] and the newer class of neuraminidase inhibitors [zanamivir, oseltamivir and peramivir]. However, vaccines are considered the first line of defense for reducing the excess morbidity and mortality that invariably accompany pandemics and a number of clinical trials are under way to test them

bird flu: a new emerging pandemic threat and its pharmacological intervention

Bird flu is an infection caused by avian influenza viruses, which are of different types A, B and C. Type A avian influenza viruses are the most frequently associated with avian influenza epidemics and pandemics. There are 16 hemagglutinin [H1 to H16] and 9 neuraminidase types [N1 to N9] identified till date. A peculiar characteristic of influenza A viruses is their propensity for genetic change by two main processes: antigenic drift [small, gradual changes] and antigenic shift [abrupt, major change producing a novel influenza A virus subtype]. There are various modes of transmission of human influenza including inhalation, direct or indirect [fomite] contact etc., can have manifestations ranging from mild to severe or fatal disease, depend on the viral subtype causing the disease. Avian influenza A [H5N1] results in high death rate amongst infants and young children. The first outbreak of human infection by avian influenza viruses [H5N1] was observed in 1997 in Hong Kong. Since then a large number of outbreaks have been reported in different parts of the world. In fact, the spread of avian influenza H5N1 in various species including humans has lead to a current pandemic threat. Human avian influenza infections in persons at high risk of exposure can be prevented by adopting a series of protective measures, anti-viral vaccination and health monitoring. Drugs currently available for the treatment or prophylaxis of influenza infections include the adamantanes [amantadine and rimantadine] and the newer class of neuraminidase inhibitors [zanamivir, oseltamivir and peramivir]. However, vaccines are considered the first line of defense for reducing the excess morbidity and mortality that invariably accompany pandemics and a number of clinical trials are under way to test them