Methotrexate reduction in patients starting infliximab therapy investigated

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Methotrexate reduction in patients starting infliximab therapy

investigated

The reduction of methotrexate dosage in patients with rheumatoid

arthritis beginning therapy with infliximab investigated.

According to a study from the United States, " Infliximab plus

methotrexate (MTX) is approved for the treatment of rheumatoid

arthritis (RA). Based on the benefit/risk profile of this combination

therapy, lower doses of MTX would be preferable when infliximab

efficacy can be maintained. "

R.M. Fleischmann and colleagues, University of Texas in Dallas,

explained, " We evaluated the ability of patients receiving infliximab

plus MTX to achieve and maintain a clinical response while the dose

of MTX was tapered. Infliximab infusions were administered at a

minimum dosage of 3 mg/kg at 8-week intervals (following three

loading doses at weeks 0, 2, and 6) to patients who had an inadequate

response to MTX.

MTX tapering was initiated at week 22 or later when at least a 40%

improvement in the combined tender and swollen joint count was

achieved; dosages were reduced by 5 mg every 8 weeks to a protocol-

specified minimum dosage of 5 mg per week. If the required dosage of

MTX after a flare was greater than the baseline dosage, the patient

was considered a treatment failure. "

" Of the 210 patients enrolled, 159 (76%) achieved a 40% or better

improvement in the combined tender and swollen joint count and had

their MTX doses tapered. In these 159 responders, the median (mean)

dose of MTX was reduced from 15 (16.5) mg per week at baseline to 5

(7.1) mg per week at week 54, " determined the investigators. "

" From the time of initial response, " researchers concluded, " 79% of

these patients had a zero-or a one-vial increase in infliximab,

corresponding to an approximate dose increase of 1 mg/kg, through

week 54. Approximately 75% of the patients participating in this

trial achieved at least a 40% reduction in the combined swollen and

tender joint count (correlating with an American College of

Rheumatology 20% [ACR20] response in 83% of patients) while reducing

the mean MTX dose by 57%. "

Fleischmann and colleagues published the results of their research in

Current Medical Research and Opinion (Methotrexate dosage reduction

in patients with rheumatoid arthritis beginning therapy with

infliximab: the Infliximab Rheumatoid Arthritis Methotrexate Tapering

(IRAMT) trial. Curr Med Res Opin, 2005;21(8):1181-1190).

For additional information, contact R.M. Fleischmann, University of

Texas, SW Medical Center Dallas, 5939 Harry Hines Blvd., Suite 400,

Dallas, TX 75235, USA.

The publisher of the journal Current Medical Research and Opinion can

be contacted at: Librapharm, C, O Dr. L e, 26-32 Venture

West, New Greenham Park, Newbury RG19 6HX, Berkshire, England.

Keywords: Dallas, Texas, United States, Arthritis, Clinical Response,

Combination Therapy, Drugs, Infliximab, Maintenance Dosage,

Methotrexate, Methotrexate Sodium, Pharmaceuticals, Rheumatoid

Arthritis, Rheumatology, Tapering.

This article was prepared by Science Letter editors from staff and

other reports. Copyright 2005, Science Letter via NewsRx.com.

October 14, 2005

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