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Comparison of Etanercept and Methotrexate for Early Rheumatoid Arthritis
Tumor necrosis factor is overproduced in the joints of patients with
rheumatoid arthritis, and etanercept is a soluble tumor necrosis factor
receptor fusion protein that blocks the action of this cytokine. In this
one-year study, the effects of two doses of etanercept (10 mg and 25 mg,
each given twice weekly) were compared with the effects of methotrexate.
The higher dose of etanercept was more effective than methotrexate in
ameliorating symptoms and signs, and it resulted in a slower rate of progression
of joint erosion and narrowing.
Infliximab
and Methotrexate in the Treatment of Rheumatoid Arthritis
Short-term administration of infliximab, a monoclonal antibody against tumor
necrosis factor (alpha), reduces joint inflammation in patients with rheumatoid
arthritis. This study examined the effects of two doses of infliximab, given
every 4 or 8 weeks, plus methotrexate with those of methotrexate alone for
54 weeks in 428 patients with the disease. Among the patients who were treated
with infliximab and methotrexate, 51.8 percent had a decrease in the clinical
manifestations of arthritis, as compared with 17.0 percent of the patients
given methotrexate alone.
Fecal
Occult-Blood Screening and Colorectal Cancer
Although both annual screening and biennial screening for fecal occult blood
significantly reduce mortality from colorectal cancer, the effect of screening
on the incidence of colorectal cancer is uncertain. The diagnosis and removal
of precancerous lesions as a result of screening should reduce the number
of cancers. This analysis of 18 years of follow-up data in the Minnesota
Colon Cancer Control Study shows that both annual and biennial fecal occult-blood
testing significantly reduced the incidence of colorectal cancer.
Folic
Acid Antagonists, Such as Trimethoprim and Sulfasalazine, and the Risk
of Birth Defects
 Pregnant
women who take multivitamins containing folate are less likely to have
infants with cardiovascular defects, oral clefts, and urinary tract defects
than are women who do not take multivitamins. To determine the role of
folic acid antagonism in causing these defects, the authors interviewed
the mothers of 6932 infants with one of these defects and the mothers
of 8387 control infants. The risks of cardiovascular and urinary tract
defects and oral clefts were approximately doubled by exposure to folic
acid antagonists such as trimethoprim and sulfasalazine early in gestation.
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