RESEARCH - Clinical and radiological efficacy of initial versus delayed treatment with Remicade plus MTX in patients with early RA

[Guest guest]

Ann Rheum Dis. 2008 Oct 17.

Clinical and radiological efficacy of initial versus delayed treatment

with infliximab plus methotrexate in patients with early rheumatoid

arthritis.

van der Kooij SM, le Cessie S, Goekoop-Ruiterman YP, De Vries-Bouwstra

JK, van Zeben D, Kerstens PJ, Hazes JM, van Schaardenburg D, Breedveld

FC, Dijkmans BA, Allaart CF.

LUMC, Netherlands.

OBJECTIVES: To compare the clinical and radiological efficacy of

initial versus delayed treatment with methotrexate (MTX) and

infliximab (IFX) in patients with recent onset rheumatoid arthritis

(RA).

METHODS: In a post-hoc analysis of the BeSt study, 117 patients who

started initial MTX+IFX were compared with 67 patients who started

MTX+IFX treatment after failing (disease activity score [DAS] >2.4;

median delay to IFX: 13 months) on >/=3 traditional DMARDs. If the DAS

remained >2.4, the protocol dictated IFX dose increases to 6, 7.5, and

10mg/kg. In case of a DAS </=2.4 for >/=6 months, IFX was tapered and

finally stopped. We aimed to correct for allocation bias using

propensity scores. Functional ability was measured by the Health

Assessment Questionnaire (HAQ), radiological progression by Sharp/van

der Heijde scoring (SHS).

RESULTS: Baseline differences between the initial and delayed groups

were no longer significant after propensity score adjustment. Three

years after baseline, patients treated with initial MTX+IFX

experienced more improvement in HAQ over time, and were less likely to

have SHS progression than patients treated with delayed MTX+IFX

(P=0.034). Two years after IFX initiation, more patients in the

initial group compared with the delayed group could discontinue IFX

after a good response (56% versus 29%, P=0.008).

CONCLUSIONS: The results of this post-hoc analysis suggest that using

MTX+IFX as initial treatment for recent onset RA patients is more

effective than reserving MTX+IFX for patients who failed on

traditional DMARDs, with more HAQ improvement over time, more IFX

discontinuation and less progression of joint damage.

PMID: 18930988

http://www.ncbi.nlm.nih.gov/pubmed/18930988

Not an MD