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Rituxan, cancer drug can treat rheumatoid arthritis

Rheumatoid arthritis affects over 2 million Americans every year.



2 September, 2005: Approval has been sought from the U.S. Food and Drug Administration (FDA) for a new indication for the cancer drug Rituxan (Rituximab) in patients with active rheumatoid arthritis (RA).

Biogen Idec, and Genentech, the co-marketers of the drug in the US, submitted a supplemental Biologics License Application (sBLA) with USFDA seeking nod for rituximab to treat patients who inadequately respond to an anti-TNF therapy, the companies said in a release.

The sBLA submission is based primarily on the 24-week results of a multi-center, randomized, double-blind, placebo-controlled phase III study known as REFLEX. In the trial, patients who received a single course of two infusions of Rituxan with a stable dose of methotrexate (MTX) displayed a statistically significant improvement in symptoms measured at 24 weeks, compared to those receiving placebo and MTX.

The most common side effects in the Rituxan arm of REFLEX included headache, upper respiratory tract infection and nasopharyngitis. The reported rate of serious adverse events was comparable across treatment arms. Analysis of the REFLEX 24-week data did not reveal any unexpected safety signals, and the companies continue to monitor the long-term safety of Rituxan in all clinical trials. The results of the REFLEX trial will be presented at the American College of Rheumatology meeting in San Diego in November. 

RA is a debilitating autoimmune disease that affects more than two million Americans and hinders the daily activities of sufferers. RA occurs when the immune system inappropriately attacks joint tissue, causing painful chronic inflammation and irreversible destruction of cartilage, tendons and bones, often resulting in disability. While RA has traditionally been considered a T-cell-mediated disease, emerging research suggests that other immune cells called B-cells may play multiple roles in the pathophysiology of RA, including autoantibody production, T-cell activation and cytokine production. Common RA symptoms include inflammation of the joints, swelling, fatigue, stiffness and pain. Additionally, since RA is a systemic disease, it can have effects in other tissues such as the lungs, eyes and bone marrow.

Rituxan is a therapeutic antibody that targets and selectively depletes CD-20-positive B- cells without targeting stem cells or existing plasma cells. Rituxan is also being investigated in other autoimmune diseases, including lupus, multiple sclerosis and ANCA-associated vasculitis.

Rituxan, discovered by Biogen Idec, received FDA approval in November 1997 for the treatment of relapsed or refractory low-grade or follicular, CD-20-positive, B-cell non-Hodgkin's lymphoma (NHL). Recently, Genentech and Biogen Idec submitted a regulatory filing for FDA review of Rituxan for front-line treatment of intermediate grade or aggressive CD-20-positive B-cell NHL. It also was approved in the European Union under the trade name MabThera in June 1998. Genentech and Biogen Idec co-market Rituxan in the United States, and Roche markets MabThera in the rest of the world, except Japan, where Rituxan is co-marketed with Zenyaku Kogyo Co. Ltd. Rituxan has been used to treat more than 730,000 patients worldwide. 

In NHL patients, the majority of patients experience infusion-related symptoms with their first Rituxan infusion. These symptoms include but are not limited to: flu-like fever, chills/rigors, nausea, urticaria, headache, bronchospasm, angioedema and hypotension. These symptoms vary in severity and generally are reversible with medical intervention. In rare instances, severe and fatal infusion-related reactions have occurred, nearly all of which have been associated with the first Rituxan infusion.

These events appear as manifestations of an infusion-related complex and include hypoxia, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, cardiogenic shock and tumor lysis syndrome. Patients who develop clinically significant infusion-related cardiopulmonary events should have their Rituxan infusion discontinued and receive medical treatment.

In rare instances, severe mucocutaneous skin reactions have occurred that may be associated with Rituxan therapy. Many of these reactions have been described as paraneoplastic pemphigus and are known to be associated with various B-cell lymphomas, particularly NHL and chronic lymphocytic leukemia. Patients who develop a severe mucocutaneous skin reaction should have Rituxan discontinued and receive appropriate medical treatment, including a skin biopsy to guide therapy.

Genentech is a leading biotechnology company that develops and commercializes biotherapeutics. The company has headquarters in South San Francisco, California and is traded on the New York Stock Exchange under the symbol DNA. 

Biogen Idec into development, manufacturing and commercialization of novel therapies. 



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