RESEARCH - MTX dosage reduction in patients with RA beginning Remicade

[Guest guest]

Curr Med Res Opin. 2005 Aug;21(8):1181-90.

Methotrexate dosage reduction in patients with rheumatoid arthritis

beginning therapy with infliximab: the Infliximab Rheumatoid Arthritis

Methotrexate Tapering (iRAMT) trial.

Fleischmann RM, Cohen SB, Moreland LW, Schiff M, Mease PJ, DB, Keenan

G, Kremer JM; iRAMT Study Group.

Radiant Research--Dallas, University of Texas, Southwestern Medical Center

at Dallas, Dallas, TX 75235, USA. royfleischmann@...

OBJECTIVE: Infliximab plus methotrexate (MTX) is approved for the treatment

of rheumatoid arthritis (RA). Based on the benefit/risk profile of this

combination therapy, lower doses of MTX would be preferable when infliximab

efficacy can be maintained. We evaluated the ability of patients receiving

infliximab plus MTX to achieve and maintain a clinical response while the

dose of MTX was tapered. METHODS: Infliximab infusions were administered at

a minimum dosage of 3 mg/kg at 8-week intervals (following three loading

doses at weeks 0, 2, and 6) to patients who had an inadequate response to

MTX. MTX tapering was initiated at week 22 or later when at least a 40%

improvement in the combined tender and swollen joint count was achieved;

dosages were reduced by 5 mg every 8 weeks to a protocol-specified minimum

dosage of 5 mg per week. If the required dosage of MTX after a flare was

greater than the baseline dosage, the patient was considered a treatment

failure. RESULTS: Of the 210 patients enrolled, 159 (76%) achieved a 40% or

better improvement in the combined tender and swollen joint count and had

their MTX doses tapered. In these 159 responders, the median (mean) dose of

MTX was reduced from 15 (16.5) mg per week at baseline to 5 (7.1) mg per

week at week 54. From the time of initial response, 79% of these patients

had a zero- or a one-vial increase in infliximab, corresponding to an

approximate dose increase of 1 mg/kg, through week 54.

CONCLUSION:

Approximately 75% of the patients participating in this trial achieved at

least a 40% reduction in the combined swollen and tender joint count

(correlating with an American College of Rheumatology 20% [ACR20] response

in 83% of patients) while reducing the mean MTX dose by 57%.

PMID: 16083527

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16083527 & itool=iconabstr & query_hl=16 & itool=pubmed_DocSum

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org