RESUMO
The development of new drugs is a significant activity in a university hospital that favors access to therapeutic novelties to patients. Rheumatology, whose drug armamentarium was poor in the 1980s, has benefited from the huge progresses of immunology in the 1980-1990s, allowing a therapeutic revolution in whom the academic hospital of Liège (CHU Liège) has been strongly implicated. First protocols with anti-TNF-? monoclonal antibodies have been applied in 1997. Sixty-one protocols have been initiated in rheumatoid arthritis, 12 in ankylosing spondylitis, 10 in psoriatic arthritis, 9 in systemic erythematosus lupus, 3 in giant cell arteritis, 1 in polymyalgia rheumatica, 5 in osteoarthritis and 4 in osteoporosis. Potential and pitfalls will be discussed disease by disease and also by drug categories. The balance remains globally positive, but remission is far from be reached.
La recherche clinique médicamenteuse est une activité importante dans un hôpital universitaire. Elle valide des nouveautés thérapeutiques et fait bénéficier les patients de traitements novateurs bien avant leur mise sur le marché. La rhumatologie est une discipline dont l'arsenal thérapeutique était pauvre dans les années 1980, et les immenses progrès de l'immunologie, réalisés entre 1980 et 1995, lui ont permis de vivre une véritable révolution thérapeutique à laquelle notre service a amplement participé. C'est en 1997 que les premiers traitements par anticorps monoclonaux anti-TNF-? (les traitements dits biologiques) ont été utilisés au CHU de Liège. Soixante et une études seront initiées dans la polyarthrite rhumatoïde, 12 dans la spondylarthrite ankylosante, 10 dans la polyarthrite psoriasique, 9 dans le lupus érythémateux disséminé, 3 dans l'artérite temporale de Horton, une dans la pseudopolyarthrite rhizomélique, une dans la sclérodermie, 5 dans l'arthrose, 4 dans l'ostéoporose. Les espoirs et les déceptions observées dans les différentes indications, et avec les différentes molécules, sont analysées. Le bilan est globalement positif, mais les résultats encore insuffisants que pour arriver au concept de rémission.
Assuntos
Artrite Psoriásica , Artrite Reumatoide , Polimialgia Reumática , Reumatologia , Humanos , Reumatologia/tendências , Fator de Necrose Tumoral alfaRESUMO
Benoxaprofen (600 mg once a day) and indomethacin (25 mg t.i.d.) were compared in a double-blind, randomized, crossover study in 35 ambulatory hospital outpatients suffering from osteoarthritis of the knee. Six patients on each treatment withdrew because of gastric side effects (3 patients withdrew from both treatments) and a total of 5 patients withdrew because of lack of efficacy (2 on benoxaprofen and 3 on indomethacin). Twenty-two patients were suitable for analysis of efficacy and safety. The two drugs were shown to be comparable in efficacy by both the subjective and objective parameters used to assess pain, stiffness, and movement. However, because there was no washout period between administration of the two drugs, there was a tendency for the drug given second (8 benoxaprofen versus 14 indomethacin) to have greater efficacy. Side effects reported were mostly mild in nature and mostly gastrointestinal in origin. A significant reduction in levels of alkaline phosphatase (p less than 0.005) was noted during benoxaprofen therapy.
