Drug Relieves Arthritis Pain Patients Praise Experimental ‘Monkey Juice’

Juliette Thibado was nearly knocked flat on her back four years ago by the sudden onset of rheumatoid arthritis.

The crippling pain forced her to sell her horses. She couldn’t ride anymore. Some days, she had to close her Hayden, Idaho, pet shop early and just go home to bed.

Ray Hansen’s rheumatism began creeping up on him about 16 years ago through the joints of his fingers, slowing him to the point where it took half an hour to dress each morning.

“Lying in bed so long, you just stiffen up,” Hansen said. “I just wanted to feel good.”

So Hansen, 67, and Thibado, 50, volunteered to take part in a trial run of an experimental drug known as a monoclonal antibody. Because the drug was developed with antibodies from monkeys instead of mice, doctors and patients have dubbed it “monkey juice.”

So far, it’s the best medicine that Hansen and Thibado have tried since being diagnosed with their disease - and between the two of them, they’ve tried just about everything.

The new treatments are not generally available now, and it may be two years before they obtain federal approval.

“If you happen to have rheumatoid arthritis, now is a good time to have it,” said Dr. Craig Wiesenhutter, a rheumatology and immunology specialist in Coeur d’Alene.

And the Inland Northwest is a good place to have it.

Wiesenhutter and Spokane colleague Scott Baumgartner have been involved in studies of new drugs, called “biologics,” that are among the most promising advances in the treatment of rheumatoid arthritis in recent years.

The two presented their results at the national meeting of the American College of Rheumatology in Orlando, Fla., last week, attracting national attention.

Last week, the new treatments were featured in Time magazine.

Wiesenhutter hopes to start the third phase of testing of “monkey juice” in about two weeks. Baumgartner already has started the next phase of testing of a biologic drug produced by Immunex Corp. of Seattle.

“Our hopes are high,” Baumgartner said. “We’ve been waiting for these (biologics) for years. All of a sudden, we start seeing that not only do they work, but they also seem to be safe.”

“It’s like our dream come true,” Wiesenhutter said.

The worst side effect Wiesenhutter found with the new antibody was a rash at high doses, which disappeared when the drug was discontinued.

Neither Hansen nor Thibado suffered any side effects, and relief lasted about six months after treatment.

The treatment took one month and involved twice-weekly trips to a doctor for injections.

Some of Baumgartner’s patients had redness and swelling where their shots were given, and a few had a higher tendency to develop minor upper respiratory problems such as colds and chest congestion.

But compared with standard treatments for rheumatoid arthritis - aspirin, gold injections and the cancer drug methotrexate - the side effects were minimal.

“I would do it again in a heartbeat,” Thibado said.

Rheumatoid arthritis is a disease of the immune system. Instead of being deficient, however, the immune system of a rheumatoid patient is overactive and attacks cells in the joints.

More than 2 million Americans suffer from the disease, which causes pain, swelling, stiffness, deformities and loss of mobility. It also can lead to problems with eyes, blood vessels, the lungs and the heart.

Until recently, the favored treatment for rheumatoid arthritis was to use steroids or anti-cancer drugs to suppress the hyperactive immune system.

Biologics work differently because they target particular types of cells instead of the entire system. So far, they don’t appear to make patients susceptible to other diseases and infections.

“Monkey juice” is an antibody that interferes with the T cells, which are the cells that sound the “call to arms” to attack an infection, Wiesenhutter said.

In the case of rheumatoid arthritis, the T cells have “run amok” and are inciting other cells to attack an infection that doesn’t exist, he said.

While the pharmaceutical company SmithKline Beecham has hired Wiesenhutter to help it test the antibody that targets T cells, Immunex of Seattle has hired Baumgartner to test a genetically engineered protein that targets the proteins that actually cause the damage to joints.

Immunex’s proteins work by binding with the attacking proteins, rendering them ineffective.

Wiesenhutter has treated 15 patients locally with the antibody in a study that involved 136 patients around the world. Of those taking a high dose of the antibody, 77 percent showed significant improvement over four weeks of treatments.

“It’s one of the most dramatic responses we’ve ever witnessed in rheumatology research,” Wiesenhutter said.

Some patients showed improvements within three hours, and Wiesenhutter claims two patients danced jigs in the hallway when they came in for their next treatment.

“My mind started working good again; the depression lifted,” Thibado said. “I was not tired. I could move and do things. … It just made me happy.”

But now, the treatments are wearing off for Thibado and Hansen. Hansen is feeling achy in his shoulders and elbow as well as the usual locations.

While the new treatments offer hope, they won’t be on the market until the U.S. Food and Drug Administration approves them. That could be 1998 or later.

Until then, sufferers of rheumatoid arthritis will have to settle for the usual array of drug treatments or contact a rheumatologist to get involved in experimental studies.

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