Remicade in active early rheumatoid arthritis

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Ann Rheum Dis. 2004 Feb; 63(2): 149-155.

Infliximab in active early rheumatoid arthritis.

Breedveld FC, Emery P, Keystone E, Patel K, Furst DE, Kalden JR, St

Clair EW, Weisman M, Smolen J, Lipsky PE, Maini RN.

Department of Rheumatology, University of Leiden, Leiden, The

Netherlands. Academic Unit of Musculoskeletal Disease, Department of

Rheumatology, University of Leeds, Leeds, UK. University of Toronto,

Toronto, Canada. Centocor, Inc., Malvern, PA, USA. University of

California at Los Angeles, School of Medicine, Los Angeles, CA, USA.

Department of Internal Medicine III and Institute for Clinical

Immunology, University Erlangen-Nuremberg, Germany. Division of

Rheumatology and Immunology, Duke University Medical Center, Durham, NC,

USA. University of California at Los Angeles, School of Medicine, Los

Angeles, CA, USA. Department of Rheumatology, University of Vienna, and

2nd Department of Medicine, Lainz Hospital, Vienna, Austria. Intramural

Research Program, National Institute of Arthritis and Musculoskeletal

and Skin Diseases, Bethesda, MD, USA. The Kennedy Institute of

Rheumatology and the Imperial College School of Medicine, London, UK.

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.

PMID: 14722203

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