Iguratimod (T-614) is a novel disease modifying anti-rheumatic drug (DMARD). Iguratimod is characterized by inhibitory effects on immunoglobulin production in B cells as well as inhibiting cytokine production. Its' mode of action comes by suppression of nuclear factor kappa B (NF-kB) activation. As I have already written this before, please look for the links below. 2012 there had been three studies, 2013 one study at the EULAR Meeting in Madrid (a study by a Chinese group) and also only one study at the ACR 2013 Meeting.
This time there have been three posters/abstracts on iguratimod. But alas, all with a very limited number of patients.
K. Kume and colleagues presented: "THE EFFICACY AND SAFETY OF IGURATIMOD IN RHEUMATOID ARTHRITIS PATIENTS WITH CHRONIC RENAL FAILURE". Conclusions: "Iguratimod was effective and safety in RA patients with chronic renal failure. Iguratimod could be used for RA patients with chronic renal failure." But: N=21, of whom 18 completed the study!
K. Okamura and colleagues presented: "CLINICAL EFFICACY OF THE SYNTHETIC ANTI-RHEUMATIC DRUG, IGURATIMOD". Conclusions: "Our results suggest that IGU is clinically one of the useful synthetic DMARDs to RA patient." N=41 over 24 weeks. No placebo controlled study.
Y. Hirano looked at: "INFLUENCES OF DISEASE ACTIVITY AT INITIATION OF IGURATIMOD, A SMALL-MOLECULE ANTIRHEUMATIC DRUG, ON EFFICACY OF IGURATIMOD IN PATIENTS WITH RHEUMATOID ARTHRITIS: A MULTICENTER STUDY". Conclusions: "More treatment options other than sufficient MTX and BIO are needed in RA patients with concomitant disease such as lung disease or renal dysfunction. High cost of BIO is another issue to inhibit improvement of signs and symptoms in RA patients. This study suggests that IGU is one of the options not only in RA patients treated with sufficient MTX but also in RA patients with high disease activity treated with insufficient MTX." N=34 over 24 weeks.
I think iguratimod has shown to be a promising candidate for treatment of active rheumatoid arthritis and might become a needed alternative in the conventional (traditional) DMARD class, but the sponsor of studies must show more commitment. Now, we don't need more of the above studies. What we need are double-blind placebo controlled studies with enough patients over a longer period of time. And we need data, if radiographic progression is inhibited or not.
Iguratimod - go for it!
Iguratimod at the EULAR Meeting 2012
Iguratimod at the EULAR Meeting 2013
Iguratimod at the ACR 2013 Meeting