RESEARCH - Efficacy of initial versus delayed treatment of early RA with Remicade plus MTX

[Guest guest]

Ann Rheum Dis published online 17 Oct 2008;

Schaardenburg, Ferry C Breedveld, Ben AC Dijkmans and Cornelia F Allaart

De Vries-Bouwstra, Derkjen van Zeben, Pit JSM Kerstens, J MW Hazes, Dirkjan van

Sjoerd M van der Kooij, Saskia le Cessie, PM Goekoop-Ruiterman, Jeska K

" Clinical and radiological efficacy of initial versus delayed

treatment with infliximab plus methotrexate in patients with early

rheumatoid arthritis " :

ABSTRACT

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.

**********************************

Read the full article here:

http://ard.bmj.com/cgi/rapidpdf/ard.2008.093294v1.pdf

Not an MD