Increasing Infliximab Dose May Not Benefit Patients with Rheumatoid Arthritis

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Increasing Infliximab Dose May Not Benefit Patients with Rheumatoid

Arthritis

A DGReview of : " Dose escalation of infliximab in clinical practice:

improvements seen may be explained by a regression-like effect "

ls of the Rheumatic Diseases (ARD Online)

04/02/2004

By Jill

Dose increases of infliximab for the treatment of rheumatoid arthritis (RA)

may not yield the clinical benefit expected, Swedish researchers have found.

Rheumatologists often increase infliximab dosage in cases of inadequate

response to the original dose or short-lived treatment effect. However, dose

escalation significantly increases treatment cost and clinical improvement

has not been demonstrated.

Using data from the Stockholm TNF-alpha follow-up registry (STURE),

F. van Vollenhoven, MD, PhD, and colleagues of the Department of

Rheumatology, Karolinska Hospital, Stockholm, performed a study to determine

whether an infliximab dose above 3 mg/kg/infusion results in better clinical

outcome in rheumatic diseases.

The researchers compared clinical outcomes in 3 groups: 44 patients with RA

whose infliximab doses were increased to 5 to 7 mg/kg/infusion, 44 patients

treated with infliximab without dose increases, and 36 patients treated with

etanercept.

Analysis showed the average disease activity score (DAS28), swollen joint

count, and numerical American College of Rheumatology responses

significantly improved after dose increase, but the magnitude of improvement

was modest. Furthermore, the values after dose increase were similar to the

best results obtained previous to dose increase.

In addition, DAS28 and swollen joint count values in each group showed the

same pattern of worsening and subsequent improvement with or without

infliximab dose increase, with numerically similar changes in outcome that

were not statistically different.

Dr. van Vollenhoven and colleagues note that during informal case review,

they found a tendency among treating physicians to assess the results of

infliximab dose escalation as better than was warranted by outcome, and that

dose increases were rarely reversed when no improvement was observed.

" We recommend that formal studies of infliximab dose escalation be

undertaken and that individual physicians wishing to increase infliximab

dosage do so under very clearly prespecified conditions of follow up, " they

concluded.

Ann Rheum Dis 2004 Apr;63:4:426-30