RESEARCH - Radiographic benefit with Remicade + MTX despite no clinical improvement

[Guest guest]

Arthritis Rheum. 2005 Apr;52(4):1020-30.

Evidence of radiographic benefit of treatment with infliximab plus

methotrexate in rheumatoid arthritis patients who had no clinical

improvement: A detailed subanalysis of data from the anti-tumor necrosis

factor trial in rheumatoid arthritis with concomitant therapy study.

Smolen JS, Han C, Bala M, Maini RN, Kalden JR, van der Heijde D, Breedveld

FC, Furst DE, Lipsky PE.

Medical University of Vienna and Lainz Hospital, Vienna, Austria.

OBJECTIVE: To assess the relationship between inflammation and joint

destruction in rheumatoid arthritis (RA) patients who have not responded

clinically to treatment. METHODS: Changes from baseline to week 54 in

clinical variables and measures of radiographic progression were compared

between patients who received infliximab (3 mg/kg or 10 mg/kg every 4 or 8

weeks) plus methotrexate (MTX) and those who received MTX plus placebo in

the Anti-Tumor Necrosis Factor Trial in RA with Concomitant Therapy trial.

RESULTS: At week 54, patients who did not show 20% improvement by American

College of Rheumatology criteria (ACR20 nonresponders) while receiving

infliximab plus MTX exhibited mild but statistically significant improvement

in clinical variables, including the 28-joint Disease Activity Score (DAS28)

(P < 0.001), tender joint count (P = 0.014), swollen joint count (P <

0.001), and C-reactive protein (CRP) level (P < 0.001). Whereas the clinical

and CRP changes among ACR20 nonresponders to infliximab plus MTX were small

and much lower than among ACR20 responders to this treatment, radiographic

progression among ACR20 nonresponders to infliximab plus MTX was

significantly inhibited (P < 0.001) compared with ACR20 nonresponders to MTX

plus placebo. Radiographic progression was much greater in patients

receiving MTX plus placebo than in patients receiving infliximab plus MTX,

irrespective of ACR response status (mean change in modified Sharp/van der

Heijde score 6.0 in ACR20 responders and 7.2 in ACR20 nonresponders in the

MTX plus placebo-treated group, versus 0.1 in ACR20 responders and 1.2 in

ACR20 nonresponders in the infliximab plus MTX-treated group). Furthermore,

among patients who were ACR20 nonresponders through week 54, patients who

were DAS nonresponders at weeks 30 and 54, and patients without any

improvement in individual clinical variables, those receiving infliximab

plus MTX still demonstrated inhibition of structural damage that was

statistically significant compared with inhibition in patients who received

MTX plus placebo (P < 0.05 to P < 0.001).

CONCLUSION: Even in patients without clinical improvement, treatment with

infliximab plus MTX provided significant benefit with regard to the

destructive process, suggesting that in such patients these 2 measures of

disease are dissociated.

PMID: 15818697

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5818697 & dopt=Abstract

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org