Infliximab in active early rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 63; no. 2; pp. 149 - 155
• Main Authors: Breedveld, F C, Emery, P, Keystone, E, Patel, K, Furst, D E, Kalden, J R, St Clair, E W, Weisman, M, Smolen, J, Lipsky, P E, Maini, R N
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.02.2004; BMJ; BMJ Publishing Group Ltd; Elsevier Limited
• Subjects: Acute Disease; Analysis of Variance; Anti-TNF Therapy in RA with Concomitant Therapy; Antibodies, Monoclonal - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; ATTRACT; Biological and medical sciences; disease modifying antirheumatic drug; Disease Progression; Diseases of the osteoarticular system; DMARD; Drug Administration Schedule; Drug Therapy, Combination; early rheumatoid arthritis; Extended Report; Female; Finger Joint - diagnostic imaging; Foot Joints - pathology; Humans; Inflammatory joint diseases; Infliximab; Male; Medical sciences; methotrexate; Methotrexate - therapeutic use; Middle Aged; modified van der Heijde-Sharp score; MTX; Radiography; radiological progression; Rheumatoid arthritis; SDD; smallest detectable difference; Studies; TNF; Tumor necrosis factor-TNF; tumour necrosis factor; Immunopathology; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Monoclonal antibody; Immunomodulator; Chronic; Infliximab; Rheumatoid arthritis; Anticytokine; Early; Immunosuppressive agent; Tumor necrosis factor α
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2003.013961

Objective: To examine the impact of the combination of infliximab plus methotrexate (MTX) on the progression of structural damage in patients with early rheumatoid arthritis (RA). Methods: Subanalyses were carried out on data for patients with early RA in the Anti-TNF Therapy in RA with Concomitant Therapy (ATTRACT) study, in which 428 patients with active RA despite MTX therapy received placebo with MTX (MTX-only) or infliximab 3 mg/kg or 10 mg/kg every (q) 4 or 8 weeks with MTX (infliximab plus MTX) for 102 weeks. Early RA was defined as disease duration of 3 years or less; 82 of the 428 patients (19%) met this definition. Structural damage was assessed with the modified van der Heijde-Sharp score. The changes from baseline to week 102 in total modified van der Heijde-Sharp score were compared between the infliximab plus MTX groups and the MTX-only group. Results: The erosion and joint space narrowing scores from baseline to week 102 in the cohort of patients with early RA decreased significantly in each infliximab dose regimen compared with the MTX-only regimen. Consistent benefit was seen in the joints of both hands and feet. Conclusions: Infliximab combined with MTX inhibited the progression of structural damage in patients with early RA during the 2 year period of treatment. Early intervention with infliximab in patients with active RA despite MTX therapy may provide long term benefits by preventing radiographic progression and preserving joint integrity.