RESEARCH - Remicade and MTX as induction therapy in patients with early RA

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Arthritis Rheum. 2007 Jul;56(7):2129-34.

Infliximab and methotrexate as induction therapy in patients with

early rheumatoid arthritis.

van der Bijl AE, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Ten Wolde

S, Han KH, van Krugten MV, Allaart CF, Breedveld FC, Dijkmans BA.

Leiden University Medical Center, Leiden, The Netherlands.

OBJECTIVE: To evaluate the efficacy of infliximab plus methotrexate

(MTX) as induction therapy in patients with early rheumatoid arthritis

(RA).

METHODS: Disease-modifying antirheumatic drug (DMARD)-naive patients

with active, early RA who were included as group 4 of the BeSt study

were initially treated with infliximab (3 mg/kg) in combination with

MTX (25 mg/week). The Disease Activity Score (DAS) was measured every

3 months. In patients with persistent low disease activity (DAS

<or=2.4) for at least 6 months, the infliximab dosage was tapered and

finally discontinued; the MTX dosage then was tapered to 10 mg/week.

In patients with a DAS of >2.4, the infliximab dosage was increased

(maximum 10 mg/kg), and they were subsequently switched to another

DMARD. Except for intraarticular administration, corticosteroids were

not permitted. Functional ability and the modified Sharp/van der

Heijde score were determined after 2 years of therapy.

RESULTS: Of the 120 patients, 67 responders (56%) had persistent low

disease activity and discontinued infliximab after a median of 9.9

months, with a median MTX dosage of 10 mg/week after 2 years. Ten

other patients experienced a disease flare after discontinuation and

resumed infliximab after a median of 3.7 months. Thirteen patients did

not achieve persistent low disease activity and received infliximab at

various dosages. Treatment was unsuccessful in 30 patients. In the 67

responders, the progression of joint damage was lower than in the 30

patients in whom treatment failed.

CONCLUSION: Fifty-six percent of patients with active early RA,

initially treated with infliximab plus MTX, could discontinue

infliximab after achieving a DAS of <or=2.4. Low disease activity was

maintained in these patients while the MTX dosage was tapered to 10

mg/week.

PMID: 17599726

http://www.ncbi.nlm.nih.gov/pubmed/17599726

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