Last week Johnson and Johnson/Centocor won it's patent law suit against Abbott concerning Humira. The jury trial concluded that adalimumab (Humira) inpinged on J&J's patent for infliximab, and awarded them 1.7 billion dollars. Apparently they felt that the fully human antibody was not adequately different from infliximab. Hard to believe that a jury is left to ponder these kind of decisions. In any case, Abbott would continue to sell their drug but would owe royalties. Given that sales of Humira in 2008 were in the order of 4.5 billion dollars, we're talking about serious cash. Not that Abbott is caving though. They're appealing the decision and counter suing J&J over Symponi, J&J's own fully human anti-TNF that is just now coming out. Could be amusing.
Interesting times ahead I think.
When I started my practice many years ago I had to do internal medicine call. It was good in some respects, keeping my well-earned internal medicine skills sharp, but after a while I had to question the appropriateness of a rheumatologist handling drug overdoses and pre-eclampsia. I then restricted my call to rheumatology and allergy since we were in the same department, and finally to rheum call alone. After a decade with little general internal med I can see that I've now become a bit rusty. Heart sounds are now limited to present or not present. I pray infections I stumble upon are treatable with the three antibiotics I know, and hope that they are still being manufactured. Where's chloramphenicol when you need it? I actually read the computer generated ecg report, and I completely ignore, so far without any perceptible negative consequence, all D-dimer results.
But chest x-rays are still just chest x-rays and even I can see that the film in a recent article of Nature Reviews Rheumatology was a bit off. The article discusses leflunomide induced lung disease but it would appear that it also causes dextrocardia:

The incidence of ILD in the cohort decreased over time, as fewer patients with pre-existing ILD were prescribed the drug following the issue of a safety notice in January 2004. Although not mentioned in the safety notice, the use of a loading dose also declined.
In a separate study, a UK-based group reviewed the clinical characteristics of 32 published cases (including 6 from Japan) of leflunomide-induced pneumonitis in patients with RA. The investigators were prompted to undertake the retrospective review after finding a dearth of information in the literature and clinical guidelines.
When I went through first year of med school some twenty five years ago, one of my least favourite courses was histology. We had a great teacher and great labs, but the problem was that we had so much of it. Eight months if I'm not mistaken, and many hours a week. I remember thinking that this was way, way too much. Apparently somebody was listening.
Took some time off from blogging. After two years it was good to take a break but I must admit, after a prolonged lay-off, it's hard to get restarted. It's not that there isn't stuff to talk about, after all, rheumatology changes every day. And it's fun. How often can we talk about hockey chants and rheumatology in normal circles? In fact, when can we ever put pen to paper, so to speak, outside of our daily practice?
Been a while since I've posted but I have an excuse. A few of them. It's tax time and since my filing system is more primitive than the shoe box technique, a few nights attention each year is obligatory. The Montreal Canadiens were in the playoffs. It's embarrassing to say but that problem was solved in quick order by the Boston Bruins. As of tonight, I'm a Vancouver Canucks fan. Most importantly, my computer went nuts. I'm not computer savvy but I can usually figure out the minor glitches after a while but this time I didn't know where to start. I could not get either my browser nor mail to get onto the internet, but I-tunes would go to the Apple store without delay. I couldn't shut down or restart without unplugging. When I went to the finder to check the applications, the first letter of most, but not every, word was deleted. Now that's just weird. Eventually I had to re-install everything, but of course, everything did not re-install. Nevertheless, I'm back, if not exactly at the best of terms with my digital delinquent.
As rheumatologists, we specialize in immunosuppression. Its a knack really. Unfortunately this preoccupation occasionally leads to some rather serious infections. Fortunately its rather uncommon, but if we could reduce the incidence further, well all the better. Vaccination is of course the ideal solution and is in fact recommended by the ACR for all patients taking biologics.That said, there has been debate about the efficacy of the pneumococcus vaccine and this controversy was rekindled by a recent article in the CMAJ.
"Okay Alex I'll take 'What are we' for 2000."