Why the RA Drug Humira Fails Some Patients - Arthritis and Arthritic Conditions, Medications, Symptoms, and Treatment on MedicineNet.com

Why the RA Drug Humira Fails Some Patients - Arthritis and Arthritic Conditions, Medications, Symptoms, and Treatment on MedicineNet.com

By Jenifer Goodwin
HealthDay ReporterLatest Arthritis News
Exercise Is Key for People With Arthritis: Expert Doctors Need to Improve Guidance on Arthritis Health Tip: Take Care of Arthritic Joints New Evidence of Fracture Risk From Bone Drugs Psoriasis Guidelines Call for Tailored Treatment Want More News? Sign Up for MedicineNet Newsletters! TUESDAY, April 12 (HealthDay News) -- In a new study, close to a third of patients taking the arthritis drug Humira developed an immune system reaction to it that rendered it ineffective.

Researchers say the finding helps to explain why some people get relief from their rheumatoid arthritis symptoms while on Humira (adalimumab), which is made by Abbott Laboratories, while others gain little or no benefit. Humira belongs to a class of drugs known as biologics.

In those people for whom the drug is ineffective, the immune system realizes the drug is a foreign substance and develops antibodies to it, researchers explained. Those antibodies bind to the drug and prevent it from working.

"What the publication shows is that Humira, like many other biologic agents, may induce an immunological response against the drug," said senior study author Dr. Gerrit Jan Wolbink, a rheumatologist at Jan van Breemen Research Institute in the Netherlands. "The immunological response works against the drug. This is one of the explanations why some patients do not respond the way we hope they will."

Patients who were also taking methotrexate, another arthritis drug and an immunosuppressant, were less likely to develop the antibodies, according to the study in the April 13 issue of the Journal of the American Medical Association.

Researchers followed 272 patients taking Humira for about three years.

About 28 percent developed immune system antibodies against the drug. The reaction tended to happen within the first few months of starting treatment: About 67 percent of those who developed antibodies did so during the first 28 weeks.

Patients without antibodies had more of the drug circulating in their blood. Lower levels of the drug are a sign that the body's immune system is fighting the drug and it's being removed from the body, Jan Wolbink explained.

Whether or not patients developed antibodies was also linked to whether they got relief from their rheumatoid arthritis while on Humira.

Nearly half -- 48 percent -- of those without antibodies experienced a significant reduction of their arthritis symptoms while taking the drug, while only 13 percent of those who developed antidrug antibodies got similar relief.

And while 34 percent of patients without antibodies experienced remission, only 4 percent of those who developed antibodies did.

Patients who developed antibodies were also more likely to drop out of the study because of "treatment failure."

Humira is a tumor necrosis factor (TNF) inhibitor, which works by blocking the action of TNF, a substance known as a cytokine that contributes to the inflammation of rheumatoid arthritis and other conditions.

"If you make antibodies, then Humira doesn't block the action of TNF, and it doesn't work," Jan Wolbink said.

Dr. Olga Belostotsky, a rheumatologist and chief of allergy and immunology at Lennox Hill Hospital in New York City, said the research helps explain why some patients don't respond to Humira, and yet they do respond when switched to another drug in the same class of TNF inhibitors.

"It's because they don't have antibodies to the other drugs, even when it's another drug in the same group of medications," she said.

Belostotsky said the research suggests it's very important that patients start methotrexate to suppress the immune system before starting Humira.

What isn't known is why those 28 percent of patients developed antidrug antibodies while the rest didn't.

"Why antibodies develop in some people more than the others is unclear, and why people react more to some drugs than others is unclear," Belostotsky said.


Copyright © 2011 HealthDay. All rights reserved.

SOURCES: Gerrit Jan Wolbink, M.D., Ph.D., rheumatologist, Jan van Breemen Research Institute, Amsterdam, Netherlands; Olga Belostotsky, M.D., Ph.D., rheumatologist and chief, allergy and immunology, Lenox Hill Hospital, New York City; Journal of the American Medical Association, April, 13, 2011

For Killer Abs, Try Some ... Push-Ups? | ThePostGame

For Killer Abs, Try Some ... Push-Ups? ThePostGame

Not many of us love the push-up. Sure, it’s relatively safe and effective, but let’s face it, it's kind of boring. It's something we did in P.E. class.

But what if you realized that the push-up would not only help you get a stronger upper body, but also a stronger midsection?

It's true. The push-up incorporates the stabilization muscles of your core, combining an upper-body pushing movement with a plank -- one of the best and most basic exercises for your midsection.

In fact, according to Nick Tumminello, trainer and owner and operator of the Performance University gym in Baltimore, Md., the push-up can effectively replace the sit-up.


“The push-up is basically a plank position," Tumminello says, "so it’s actually a great abdominal exercise and there’s no reason to do planks if you can do (a significant number of) push-ups."

Push-ups are a higher value plank. You’re not only strengthening your abdominals by holding them still while gravity’s trying to push your hips towards the ground, but you’re also strengthening your upper-body pushing muscles: your chest, shoulders and triceps.”

What else can a push-up do for you?

For many men, the bench press is a temptress -- the key to getting a big chest and, sometimes, an inflated ego.

“How much can you bench?” is ingrained in our fitness conversations because of the tangibility of numerous 45-lb. plates on the barbell. “How many push-ups can you do?” is not, however, even though push-ups are a much better indicator of relative strength, since you’re forced to push the mass of your body against the forces of gravity and stabilize your core.

For many women, a full push-up is a tease, a noble fitness goal that’s rarely achieved despite countless sets of knee pushups and other push-up variations.

“I have seen women who can hammer out forty plus kneeling push-ups who still can’t do one regular push-up," Tumminello says. "I’ve never trained a female who can bang out forty plus or even ten plus incline push-ups at about a bench height and not be able to hammer out at least one or two pushups from the floor."

So what's the best way for both men and women to perfect the push-up? Here are some tips -- no As-Seen-On-TV equipment needed:


-- If you can only do a handful of push-ups, start with your hands on a bench and your body in a straight line from your head to your feet. As the number of push-ups you can do with your hands on a bench improves, you can move to an aerobic step and decrease the height of the step.

-- If you find your midsection sagging towards the floor before your upper body gets tired, Tumminello recommends focusing on plank and other core stability exercises to help you stay stable.

-- When doing push-ups, either from the floor or from a bench or step, don’t try to form a “T” with your upper arms. Tuck your elbows towards your midsection at roughly a 45-degree angle. “Not only does (having your elbows flared to 90 degrees) make the exercise significantly tougher on you," Tumminello says, "but it can be a lot tougher on your shoulder and your elbow joints as well."

-- At all times, keep your wrists should directly underneath your elbows. Your forearm should be perpendicular to the ground at all times, like a table leg.

-- Open your hands up and angle your fingers slightly outward. “If you turn your hands outwards," Tumminello says, "it actually starts to incorporate your lat muscles and some more muscles in your shoulders. So not only do you have more horsepower behind the push-up, which helps increase your push-up strength, but now you actually have more muscles working to stabilize your joints as well."

For most of us, push-ups are a last resort -- what we do when we can't get to the gym. But maybe the last resort should actually be first.

Dr. Joshua Brooks
Chiropractor, Fairfax VA 22031

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