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Extended report
Infliximab in active early rheumatoid arthritis
  1. F C Breedveld1,
  2. P Emery2,
  3. E Keystone3,
  4. K Patel4,
  5. D E Furst5,
  6. J R Kalden6,
  7. E W St Clair7,
  8. M Weisman8,
  9. J Smolen9,
  10. P E Lipsky10,
  11. R N Maini11
  1. 1Department of Rheumatology, University of Leiden, Leiden, The Netherlands
  2. 2Academic Unit of Musculoskeletal Disease, Department of Rheumatology, University of Leeds, Leeds, UK
  3. 3University of Toronto, Toronto, Canada
  4. 4Centocor, Inc., Malvern, PA, USA
  5. 5University of California at Los Angeles, School of Medicine, Los Angeles, CA, USA
  6. 6Department of Internal Medicine III and Institute for Clinical Immunology, University Erlangen-Nuremberg, Germany
  7. 7Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
  8. 8University of California at Los Angeles, School of Medicine, Los Angeles, CA, USA
  9. 9Department of Rheumatology, University of Vienna, and 2nd Department of Medicine, Lainz Hospital, Vienna, Austria
  10. 10Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
  11. 11The Kennedy Institute of Rheumatology and the Imperial College School of Medicine, London, UK
  1. Correspondence to:
    Professor F C Breedveld
    Department of Rheumatology, University of Leiden, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, The Netherlands; f.c.breedveldlumc.nl

Abstract

Objective: To examine the impact of the combination of infliximab plus methotrexate (MTX) on the progression of structural damage in patients with early rheumatoid arthritis (RA).

Methods: Subanalyses were carried out on data for patients with early RA in the Anti-TNF Therapy in RA with Concomitant Therapy (ATTRACT) study, in which 428 patients with active RA despite MTX therapy received placebo with MTX (MTX-only) or infliximab 3 mg/kg or 10 mg/kg every (q) 4 or 8 weeks with MTX (infliximab plus MTX) for 102 weeks. Early RA was defined as disease duration of 3 years or less; 82 of the 428 patients (19%) met this definition. Structural damage was assessed with the modified van der Heijde-Sharp score. The changes from baseline to week 102 in total modified van der Heijde-Sharp score were compared between the infliximab plus MTX groups and the MTX-only group.

Results: The erosion and joint space narrowing scores from baseline to week 102 in the cohort of patients with early RA decreased significantly in each infliximab dose regimen compared with the MTX-only regimen. Consistent benefit was seen in the joints of both hands and feet.

Conclusions: Infliximab combined with MTX inhibited the progression of structural damage in patients with early RA during the 2 year period of treatment. Early intervention with infliximab in patients with active RA despite MTX therapy may provide long term benefits by preventing radiographic progression and preserving joint integrity.

  • early rheumatoid arthritis
  • radiological progression
  • modified van der Heijde-Sharp score
  • ATTRACT, Anti-TNF Therapy in RA with Concomitant Therapy
  • DMARD, disease modifying antirheumatic drug
  • MTX, methotrexate
  • RA, rheumatoid arthritis
  • SDD, smallest detectable difference
  • TNF, tumour necrosis factor

https://doi.org/10.1136/ard.2003.013961

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