Robbing Singaporeans of mobility
A new oral drug gives patients another option if they are not responding to current rheumatoid arthritis therapies.
BY: Eleanor Yap
Patients who currently do not respond to current rheumatoid arthritis therapies can now consider another option called Xeljanz (tofacitinib citrate) by pharmaceutical company Pfizer. The new drug is like a biologic therapy but the difference is it requires no injections or infusions and is taken orally. Besides Singapore, it is approved in 41 countries including Taiwan, Malaysia, Hong Kong, Japan, Thailand, Philippines and Australia.
“We can [now] treat rheumatoid arthritis in new ways than what was treated before,” said Jeff Bote, Global Innovative Pharma Business Unit Lead for Pfizer Malaysia, Singapore and Philippines.
Before the new drug, what was available to rheumatoid arthritis sufferers was NSAIDS (non-steroidal anti-inflammatory drugs) or steroids, which have side effects like increased blood pressure, weight gain, elevated pressure in the eyes, fluid retention and mood swings. There were also non-biologic and biologic DMARDs (disease-modifying anti-rheumatic drugs), both which have improved the outcomes of the disease. However, patients may not be able to tolerate the side effects of the non-biologic DMARDs (which include nausea, vomiting, stomach pain, diarrhoea, headache, drowsiness, dizziness, etc) and are also required to be reviewed regularly while on these treatments.
Dr Chong Yong Yeow, a specialist in rheumatology at Raffles Medical Group, explained that with biologics, which were introduced 16 years ago, patients still report problems such as the drug losing its effect and patients don’t like injections with these drugs. He added: “There is no rheumatoid arthritis treatment that is effective and we are always striving to use innovative treatment.”
He shared that with the new 5mg Xeljanz, it may get wider patient acceptance and achieve efficacy. The drug is taken twice daily and results can be seen as early as one week. However, it can’t be used in combination with biologic DMARDs or with immunosuppressants such as azathioprine, cyclosporine and tacrolimus. The most common serious infections reported with Xeljanz include pneumonia, cellulitis, herpes zoster and urinary tract infection. But, Pfizer explained that the risk of serious infections of Xeljanz is lesser than or comparable to the biologic DMARDs. It added that the drug price is currently under negotiation with hospitals and is unable to be revealed.
Incidences in Singapore
Rheumatoid arthritis is a common autoimmune rheumatic disorder in Singapore and affects about one percent of the population, which is about 45,000 people, shared Dr Chong. Seventy-five percent of that figure is female, he added. Prevalence in East Asia is 0.16 percent, compared to the countries like North America, which is higher at 0.44 percent.
It is chronic and progressive, and affects small joints in the hand and feet, causing pain and stiffness. “Prevalence peaks as one ages. Without timely treatment for years, it can worsen and cause disability and reduce quality of life,” explained Dr Chong. The disorder is also associated with mental health conditions such as depression and anxiety, as well as heart disease, and it affects other tissues in the heart, lungs and eyes, and causes inflammation of blood vessels.
Rheumatoid arthritis is a severe economic burden to the whole country. According to Dr Chong, it is the 42nd highest contributor to global disability. Though there are no local figures, the nearest available figures is in Hong Kong where the average cost of rheumatoid arthritis was estimated at US$9,289 (S$13,027.82) per patient per year. With the prevalence of rheumatoid arthritis in Hong Kong being 0.3 percent, the annual total economic impact of the disorder on the society could be over US$200 million (over S$280 million).
With smoking being the most important risk factor for rheumatoid arthritis, awareness of the condition here is low and often goes undetected, shared Pfizer’s Bote.
Added Dr Chong, “Most patients tend to seek treatment later in the course of their disease with some coming only after six months from onset of symptoms. Early diagnosis [is crucial as it] can prevent permanent joint damage.”
However, medicine is only part of the treatment for rheumatoid arthritis. Patients need to do physiotherapy and exercise such as hydrotherapy and aerobics, walking and tai-chi to strengthen muscles, improve muscle flexibility, increase main joint mobility, improve heart and lung fitness, reduce stress and improve sleep.