RESEARCH - Treatment with Remicade plus MTX improves anemia in patients with RA independent of improvement in other clinical outcome measures

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Semin Arthritis Rheum. 2008 Sep 27.

Treatment with Infliximab plus Methotrexate Improves Anemia in

Patients with Rheumatoid Arthritis Independent of Improvement in Other

Clinical Outcome Measures-A Pooled Analysis from Three Large,

Multicenter, Double-Blind, Randomized Clinical Trials.

Doyle MK, Rahman MU, Han C, Han J, Giles J, Bingham CO 3rd, Bathon J.

Associate Director, Immunology, Clinical Research and Development,

Centocor Inc., Malvern, PA; Adj. Assistant Professor, University of

Pennsylvania School of Medicine, Rheumatology, Philadelphia, PA.

OBJECTIVE: To evaluate the effect of antitumor necrosis factor-alpha

monoclonal antibody infliximab treatment on anemia in patients with

rheumatoid arthritis (RA).

METHODS: Data from patients with RA who received infliximab or placebo

in the multicenter, placebo-controlled, double-blind, randomized

ATTRACT, ASPIRE, and START studies were included in this post-hoc,

pooled analysis. Infliximab (3 to 10 mg/kg) was administered every 4

or 8 weeks, and all patients received stable doses of methotrexate

(MTX). We determined the percentage of anemic patients (baseline

hemoglobin level <12 g/dL) who had an increase from baseline in

hemoglobin level greater than or equal to 1 or 2 g/dL or achieved

normal hemoglobin level at week 22. The association of improvement in

anemia with improvement in clinical parameters was also evaluated.

RESULTS: Among patients with anemia at baseline, infliximab plus MTX

treatment produced a significantly greater mean (standard deviation)

increase in hemoglobin level from baseline to week 22 (0.74 [1.12], P

< 0.0001) than placebo plus MTX (0.30 [0.92]). Significantly (P <

0.001) greater proportions of anemic patients treated with infliximab

plus MTX had either at least a 1 g/dL (40%) or at least a 2 g/dL (12%)

increase in hemoglobin level from baseline to week 22 or achieved

normal hemoglobin level (43%) when compared with placebo plus MTX (19,

5, and 28%, respectively). Greater improvement in hemoglobin level

among infliximab plus MTX-treated patients was consistently observed

across subgroups and in patients without clinical response (American

College of Rheumatology 20% response criteria) at week 22. Multiple

regression analysis indicated that the effect of infliximab plus MTX

on anemia was independent of improvement in disease activity.

CONCLUSION: Treatment with infliximab plus MTX significantly improved

hemoglobin level among anemic RA patients when compared with treatment

with placebo plus MTX, even after adjusting for improvement in disease

activity.

PMID: 18823645 [

http://www.ncbi.nlm.nih.gov/pubmed/18823645

Not an MD