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Thursday, 18 November, 1999, 12:58 GMT
Arthritis drug prompts funding worries
Rheumatoid arthritis is a highly disabling condition for many

Doctors have hailed a rheumatoid arthritis drug launched this week as a major step forward in the battle against the crippling disease.

But with scientific trials showing that virtually all sufferers could benefit from using it, the drug may present another funding nightmare for health service managers, as it is hugely more expensive than existing treatments.

Rheumatoid arthritis is caused by inflammation of the tissues surrounding joints, but it can even kill patients by causing major organ failure.

Leflunomide, marketed as Arava, is as effective as existing treatments, but works without the highly unpleasant and even dangerous side-effects.

The drug works by dampening down the powerful immune response which causes the damage to joints and tissues.

First for a decade

Its makers, Hoechst Marion Roussel, say it is the first "disease-modifying" drug for rheumatoid arthritis for a decade, and can improve quality of life by slowing disease progression.

However, a leading arthritis charity claims that the extra cost to the NHS could lead to Leflunomide being rationed.

Professor David Scott, of the department of rheumatology from King's College Hospital London said: "This is an important new product in an area where there is immense clinical need."

He said that the launched of more new drugs for the condition could make the year 2000 a "miracle year" for sufferers.

The new treatment is far more expensive
Dr David Nicholls, a research fellow for the Arthritis Research Campaign, who is based at the Rheumatology Research Unit at Addenbrooke's Hospital near Cambridge, said the drug had already made a "big difference" in the US.

"The best treatment we have had is methatrexate, which causes side-effects like liver inflammation, nausea and diarrhoea, which means that some patients can't have it.

"It's the first new drug in perhaps the last few years."

Guidelines are currently being drawn up by the British Society for Rheumatology as to which patients should be given the drug, as demand is anticipated to be fierce.

The sooner, the better

Dr Nicholls stressed that evidence showed that the sooner sufferers received the drug after diagnosis, the better the outcome would be.

"The trouble is, it will end up competing with drugs for cancer and heart disease in the NHS. What people don't realise is that rheumatoid arthritis can lead to death as well, either through organ failure or as a result of the drugs that sufferers currently take."

Methatrexate is more than 20 times cheaper than Arava, which, at 46.50 for a month's treatment, will place another burden on overstretched drug prescribing budgets.

Rheumatoid arthritis normally strikes between the ages of 30 and 40, although children and young adults can be struck down, and is believed to be caused by the triggering of the body's own immune defence mechanism against the synovial capsule which surrounds the joints, causing inflammation and damage.

Approximately one per cent of the population suffers from the disease, and about half of these will be too disabled to work ten years after diagnosis.

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See also:
02 Mar 99 |  Health
100 years of aspirin
30 Jun 99 |  Health
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