DRUGS SHOW PROMISE FOR ARTHRITIS SUFFERERS; COMBINED TREATMENT CUTS PAIN, STUDY SAYS.

Byline: Peter Hartlaub Daily News Staff Writer

For the 2 million Americans who suffer from rheumatoid arthritis, there is hope: Patients can ease pain and swelling considerably when they combine a decade-old drug with a new one, researchers said Wednesday.

In a study published today in the New England Journal of Medicine, doctors found pain and swelling decreased noticeably in 71 percent of those who took the new drug, Enbrel, with methotrexate, a widely used treatment that went on the market in 1988. By comparison, 27 percent of those who received methotrexate and a placebo saw improvement.

``I think a lot of patients are very excited,'' said Dr. Michael Weinblatt of Boston, the study's lead researcher. ``I see a lot of optimism and a lot of hope.''

Rheumatoid arthritis, which mostly affects women, is a chronic disease that attacks the joints and can cause permanent disability.

The study brings good news, but local doctors said the high cost of Enbrel - and other new drugs that recently became available to the public - put it out of reach for most.

Enbrel costs about $12,000 per year and isn't covered by Medi-Cal, according to the state Department of Health.

Another new arthritis drug that was not included in the study, Arava, costs about $3,500 per year and also is not covered by Medi-Cal.

Medi-Cal covers methotrexate, which costs about $1,500 per year for the average patient.

``This last year was the first time in 15 years that we've received two disease-modifying agents for rheumatoid arthritis. That's great news,'' said Dr. Steven Weiner, a Granada Hills rheumatologist.

But Weiner said he has only a dozen patients on Arava and one on Enbrel.

``These disease modifying agents have one major problem - the cost,'' Weiner said. ``How many people have $3,600 per month to spend on one of their drugs? Enbrel costs almost four times that.''

Van Nuys-based rheumatologist Dr. Charles Weidmann said he hasn't prescribed Enbrel yet, in part because most insurance companies don't cover it but mostly because it's still experimental.

``We don't have very good long-term data yet,'' Weidmann said. ``There's still a lot of unanswered questions.''

Weidmann said the new drugs will have nowhere near the impact that methotrexate had when it was discovered in 1988.

Methotrexate, he said, has been proven to halt the advancement of rheumatoid arthritis, much like treatments using gold did before 1988.

Unlike methotrexate and Arava, Enbrel is genetically engineered - created through biologic research instead of synthetic. As testing continues and competitors release similar drugs on the market, doctors expect the prices to decrease.

``Not everyone is using it now,'' Weiner said. ``If the cost goes down, there may be a different story.''