RESEARCH - 17% of RA patients in drug-free remission following MTX plus Remicade treatment

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One-fifth Of Rheumatoid Arthritis Patients In Drug-free Remission

Following A Specific Treatment

ScienceDaily (June 20, 2007) — Early treatment with a combination of

methotrexate and infliximab may be effective as remission induction

therapy and alter the course of early rheumatoid arthritis (RA),

according to data presented at EULAR 2007, the Annual European

Congress of Rheumatology in Barcelona, Spain.

At four year follow up, over half (51%) of the patients who started

treatment with a combination of methotrexate and infliximab in the

BeSt ('Behandel--Strategieën' or 'treatment strategies') trial had

been able to discontinue treatment with infliximab and maintained a

good response (Disease Activity Score (DAS) d2.4). 41 patients were

still taking methotrexate monotherapy at trial end. Almost one in five

(17%) of patients had reached clinical remission (DAS <1.6), with

minimal joint damage progression, and were no longer receiving any

anti-rheumatic drugs,

Study leader Dr Cornelia F. Allaart commented: " Our findings indicate

that clinical remission from RA is achievable provided effective

treatment - such as the infliximab methotrexate combination we used in

the fourth arm of this study - is administered early in the course of

the disease. "

508 patients with newly diagnosed, untreated rheumatoid arthritis from

The Netherlands were enrolled in the BeSt trial which compared four

different treatment strategies in patients with early or recent onset

rheumatoid arthritis (RA). 120 patients were randomized to arm 4 and

started initial combination therapy with methotrexate and infliximab.

At enrolment, all patients had active disease with a disease activity

score (DAS) of 4.3, and 64% of patients were classified as rheumatoid

factor positive.

Patients received infliximab 3mg/kg plus methotrexate 25mg/week at

start of the trial. Dosages of infliximab were altered in a responsive

manner according to the DAS throughout the trial.

Disease progression over the course of the trial was ascertained by

including the Health Assessment Questionairre (HAQ) as measure for

daily functioning, and the van der Heijde modification of the Sharp

score (SHS) to assess damage on hand and feet x-rays at initiation of

the trial and at 4 years.

The lowest SHS was reported in patients who had reached a stable DAS

of <1.6 or clinical remission. Predictably, the highest rate of SHS

progression was reported in patients who had failed on the combination

of methotrexate and infliximab.

The patients who had reached drug-free remission,had had active RA at

baseline (DAS 4.1), 45% were rheumatoid factor positive and 74% had

pre-existing erosions.

Of the 120 patients treated with initial methotrexate and infliximab,

30 patients failed on that therapy and proceeded to next pre-specified

treatment steps.

http://www.sciencedaily.com/releases/2007/06/070614154858.htm

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