EXTENDED REPORT

Infliximab improves health related quality of life and physical function in patients with psoriatic arthritis

A Kavanaugh¹, C Antoni², G G Krueger³, S Yan⁴, M Bala⁴, L T Dooley⁴, A Beutler⁴, C Guzzo⁴, D Gladman⁵

¹ Center for Innovative Therapy, Division of Rheumatology, Allergy, and Immunology, UCSD, San Diego, CA, USA
² Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
³ University of Utah Health Sciences Center, Salt Lake City, UT, USA
⁴ Centocor, Inc, Malvern, PA, USA
⁵ University of Toronto, Toronto, ON, Canada

Correspondence to:
Dr A Kavanaugh
Center for Innovative Therapy Division of Rheumatology, Allergy, and Immunology, University of California at San Diego 9500 Gilman Drive, La Jolla, CA 92093-0943, USA; akavanaugh{at}ucsd.edu

Objectives: To evaluate the effect of infliximab on health related quality of life (HRQoL) and physical function in patients with active psoriatic arthritis (PsA) in the IMPACT 2 trial.

Methods: 200 patients with PsA unresponsive to conventional treatment were randomised to intravenous infusions of infliximab 5 mg/kg or placebo at weeks 0, 2, 6, 14, and 22; patients with inadequate response entered early escape at week 16. HRQoL was assessed using the Short Form-36 (SF-36) at weeks 0, 14, and 24. Functional disability was assessed using the Health Assessment Questionnaire (HAQ) at every visit through week 24. Associations between changes in quality of life (SF-36) and articular (American College of Rheumatology (ACR)) and dermatological (Psoriasis Area and Severity Index (PASI)) responses were examined.

Results: Mean percentage improvement from baseline in HAQ was 48.6% in the infliximab group compared with worsening of 18.4% in the placebo group at week 14 (p<0.001). Furthermore, 58.6% and 19.4% of infliximab and placebo treated patients, respectively, achieved a clinically meaningful improvement in HAQ (that is, 0.3 unit decrease) at week 14 (p<0.001). Increases in physical and mental component summary (PCS and MCS) scores and all eight scales of the SF-36 in the infliximab group were greater than those in the placebo group at week 14 (p0.001). These benefits were sustained through week 24. Patients achieving ACR20 and PASI75 responses had the greatest improvements in PCS and MCS scores.

Conclusions: In patients with PsA, infliximab 5 mg/kg significantly improved HRQoL and physical function compared with placebo through 24 weeks.

Abbreviations: ACR, American College of Rheumatology; HAQ, Health Assessment Questionnaire; HRQoL, health related quality of life; MCS, mental component summary; MTX, methotrexate; PASI, Psoriasis Area and Severity Index; PCS, physical component summary; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNF, tumour necrosis factor

Keywords: psoriatic arthritis; infliximab; tumour necrosis factor ; quality of life; physical function

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