Short term effects of intravenous pulse MP and IFX in active RA despite MTX treatment

[Guest guest]

Ann Rheum Dis. 2004 Sep;63(9):1069-74.

A randomised comparative study of the short term clinical and biological

effects of intravenous pulse methylprednisolone and infliximab in

patients with active rheumatoid arthritis despite methotrexate

treatment.

Durez P, Nzeusseu Toukap A, Lauwerys BR, Manicourt DH, Verschueren P,

Westhovens R, Devogelaer JP, Houssiau FA.

Rheumatology Department, Cliniques Universitaires Saint-Luc, Universite

catholique de Louvain, Avenue Hippocrate, 10, B-1200 Bruxelles, Belgium.

houssiau@...

OBJECTIVES: To compare the short term clinical and biological effects of

intravenous (IV) pulse methylprednisolone (MP) and infliximab (IFX) in

patients with severe active rheumatoid arthritis (RA) despite

methotrexate (MTX) treatment. METHODS: Patients with active RA despite

MTX treatment were randomly allocated to receive a single IV infusion of

MP (1 g) or three IV infusions of IFX (3 mg/kg) on weeks 0, 2, and 6.

Patients were " blindly " evaluated for disease activity measures. Quality

of life (QoL) was evaluated through the SF-36 health survey. Serum

matrix metalloproteinase-3 (MMP-3) titres were measured at baseline,

weeks 2 and 6. RESULTS: Compared with baseline, significant improvement

was noted in all activity measures, including serum C reactive protein

(CRP) titres, in the IFX group only. At week 14, 6/9 (67%) and 4/9 (44%)

IFX patients met the ACR20 and 50 response criteria, while this was the

case in only 1/12 (8%) and 0/12 (0%) MP patients, respectively (p<0.05).

None of the QoL scales improved with MP treatment, whereas some did so

in the IFX group. Serum MMP-3 titres significantly decreased (41% drop)

at week 6 in the IFX group, while no changes were seen in patients given

MP.

CONCLUSION: This short term randomised comparative study demonstrates

that TNF blockade is better than MP pulse therapy in a subset of

patients with severe refractory RA, with improvement in not only

clinical parameters of disease activity but also biological inflammatory

indices, such as serum CRP and MMP-3 titres.

PMID: 15308515

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org