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Clinical and radiological efficacy of initial versus delayed treatment with infliximab plus methotrexate in patients with early rheumatoid arthritis
  1. Sjoerd M van der Kooij (smvanderkooij{at}lumc.nl)
  1. LUMC, Netherlands
    1. Saskia le Cessie (cessie{at}lumc.nl)
    1. LUMC, Netherlands
      1. Yvonne PM Goekoop-Ruiterman (y.p.m.goekoop{at}lumc.nl)
      1. Leiden University Medical Center, Netherlands
        1. Jeska K De Vries-Bouwstra (jkdevriesbouwstra{at}lumc.nl)
        1. VUmc, Netherlands
          1. Derkjen van Zeben (j.vanzeben{at}sfg.nl)
          1. Sint Franciscus Hospital, Netherlands
            1. Pit JSM Kerstens (p.kerstens{at}janvanbreemen.nl)
            1. Jan van Breemen, Netherlands
              1. J MW Hazes (j.hazes{at}erasmusmc.nl)
              1. University Hospital Rotterdam, Netherlands
                1. Dirkjan van Schaardenburg (d.v.schaardenburg{at}janvanbreemen.nl)
                1. Jan van Breemen Institute, Netherlands
                  1. Ferry C Breedveld (f.c.breedveld{at}lumc.nl)
                  1. University Hospital Leiden, Netherlands
                    1. Ben AC Dijkmans (bac.dijkmans{at}vumc.nl)
                    1. VUmc, Netherlands
                      1. Cornelia F Allaart (c.f.allaart{at}lumc.nl)
                      1. LUMC, Netherlands

                        Abstract

                        Objectives: To compare the clinical and radiological efficacy of initial versus delayed treatment with methotrexate (MTX) and infliximab (IFX) in patients with recent onset rheumatoid arthritis (RA).

                        Methods: In a post-hoc analysis of the BeSt study, 117 patients who started initial MTX+IFX were compared with 67 patients who started MTX+IFX treatment after failing (disease activity score [DAS] >2.4; median delay to IFX: 13 months) on ≥3 traditional DMARDs. If the DAS remained >2.4, the protocol dictated IFX dose increases to 6, 7.5, and 10mg/kg. In case of a DAS ≤2.4 for ≥6 months, IFX was tapered and finally stopped. We aimed to correct for allocation bias using propensity scores. Functional ability was measured by the Health Assessment Questionnaire (HAQ), radiological progression by Sharp/van der Heijde scoring (SHS).

                        Results: Baseline differences between the initial and delayed groups were no longer significant after propensity score adjustment. Three years after baseline, patients treated with initial MTX+IFX experienced more improvement in HAQ over time, and were less likely to have SHS progression than patients treated with delayed MTX+IFX (P=0.034). Two years after IFX initiation, more patients in the initial group compared with the delayed group could discontinue IFX after a good response (56% versus 29%, P=0.008).

                        Conclusions: The results of this post-hoc analysis suggest that using MTX+IFX as initial treatment for recent onset RA patients is more effective than reserving MTX+IFX for patients who failed on traditional DMARDs, with more HAQ improvement over time, more IFX discontinuation and less progression of joint damage.

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