If you are suffering from Rheumatoid Arthritis (RA), you must have definitely gone through the dilemma of choosing the stream of medicine (Allopathic/ herbal/ ayurveda/ homeopathy)
During the initial consultation, I often notice that many RAers are misinformed about the allopathic anti arthritis drugs (either by general public or the alternative medicine practitioners) that —
· Allopathic anti-arthritis medicines are all steroids or pain-killers.
· Allopathy does not have any medicine for RA.
· RA never settles.
· Allopathic medicines are ‘powerful’ & eventually lead to kidney failure.
However, the truth is here—
· Allopathic anti arthritis medicines (DMARDs) are not steroids/ pain killers. They are actual drugs that hit the arthritis process.
· We do have effective medicines for RA & RA does get controlled in most of the patients.
While treating RA, the aim of a Rheumatologist is—
· To put the RA in remission as soon as possible.
· Long term steroids/ analgesics have no role in routine RA.
· To control RA activity with DMARDs/ biologics alone with analgesics only for flares.
Having said that, let us have a look at the side effects of the common DMARDs. I will keep an absolute neutral approach to avoid any bias. This will also be a scientific process with references to what we discuss. We will have a look at one DMARD at a time in the subsequent blogposts.
Before really looking at individual DMARD, let us have a look at the drug discovery process of any allopathic medicine. Each allopathic drug has to pass through a rigorous scientific process before hitting the doctor’s pen. The journey starts with scientific studies justifying the use of a molecule in any disease. This is followed by the study of the molecule in test tube & animals (Pre-clinical study). This is followed by a similar study in human subjects (Phase I to III to determine safety, tolerability & efficacy). The entire process takes anywhere between 10- 15 years !!
There are many examples of drugs being discarded due the side effects found in this process (eg. Ocrelizumab- a biologic drug for RA, Lupus, Multiple sclerosis was dumped during the clinical studies due to side effects) The average cost of research & development of a new drug entity is approximately US$1.8 billion.
Once the drug hits the market & is being prescribed, the post-marketing surveillance (Phase-IV) start. This includes looking for any unexpected side effects. Allopathic medicines have the advantage of scrutiny in multiple countries & consequent reporting of side effects from any part of the world. Cox-2 inhibitors have been one of the best examples of this level of scrutiny. They were banned once cardiovascular side effects were observed after their marketing & availability in the markets.
So, when it comes to allopathic medicines, be assured that a lot of efforts & time (remember the average time for a new drug is 10- 15 years!) have gone into ensuring your safety. Allopathic medicines are not a result of someone’s whims & fancy/ experience alone. In contrast, no such trials/ scrutiny exists for the herbal medicines/ magic cure medicines. In fact, most of the times, the contents of herbal medicines are not even printed on the pack.
Having said this, there is NOT A SINGLE MEDICINE WITHOUT ANY SIDE EFFECT. A drug is approved only when its benefits are many times more than its side effects. For any drug, there are a few side effects & having known that, there are checks & precautions as well as tests for early diagnosis of any side effect.
We will have a look at individual DMARD & its side effect profile in the subsequent blogs.
1) Ocrelizumab — http://www.fiercebiotech.com/story/patient-death-mars-promising-ms-results-phii-ocrelizumab-trial/2010-10-18?utm_medium=nl&utm_source=internal
2) Ocrelizumab –http://www.reuters.com/article/idUSLDE62705720100308
3)cost of drug discovery process- Steven M. Paul, Daniel S. Mytelka, Christopher T. Dunwiddie, Charles C. Persinger, Bernard H. Munos, Stacy R. Lindborg & Aaron L. Schacht (2010). “How to improve R&D productivity: the pharmaceutical industry’s grand challenge”. Nature Reviews Drug Discovery 9 (3): 203–214. doi:10.1038/nrd3078. PMID 20168317.