PT  - JOURNAL ARTICLE
AU  - Tsutomu Takeuchi
AU  - Nobuyuki Miyasaka
AU  - Yoshihiko Tatsuki
AU  - Toshiro Yano
AU  - Toru Yoshinari
AU  - Tohru Abe
AU  - Takao Koike
TI  - Baseline tumour necrosis factor alpha levels predict the necessity for dose escalation of infliximab therapy in patients with rheumatoid arthritis
AID  - 10.1136/ard.2011.153023
DP  - 2011 Jul 01
TA  - Annals of the Rheumatic Diseases
PG  - 1208--1215
VI  - 70
IP  - 7
4099  - http://ard.bmj.com/content/70/7/1208.short
4100  - http://ard.bmj.com/content/70/7/1208.full
SO  - Ann Rheum Dis2011 Jul 01; 70
AB  - Objectives To investigate the possible role of baseline plasma tumour necrosis factor alpha levels (baseline-TNF) on the clinical response to infliximab in patients with rheumatoid arthritis (RA). Methods Patients with RA refractory to methotrexate received 3, 6, or 10 mg/kg of infliximab every 8 weeks, in a randomised, double-blind manner: the RISING study. Clinical response (disease activity score in 28 joints based on C-reactive protein or American College of Rheumatology core set) at week 54 and serum infliximab levels were compared in three patient groups with low, intermediate, or high baseline-TNF (TNF-low, TNF-int, or TNF-high). Results In TNF-low patients, the clinical response to different doses of infliximab was comparable, whereas TNF-int patients exhibited a dose-dependent trend. In contrast, TNF-high patients (approximately 13% of the total patients) had a clinical response to 10 mg/kg significantly better than the response to 3 and 6 mg/kg of infliximab. In TNF-high patients, the median trough serum levels of infliximab were below the detection limit (<0.1 μg/ml) at 3 and 6 mg/kg but were greater than 2 μg/ml at 10 mg/kg, whereas the levels were approximately 1 μg/ml for each dosage group in TNF-low patients. Conclusion In patients with RA, baseline-TNF is significantly associated with the clinical response to infliximab in patients with a high baseline-TNF. A higher dose of infliximab may be necessary in these patients, whereas lower doses of infliximab are sufficient for those with a low baseline-TNF. Baseline-TNF may be a useful measure for personalising the treatment of RA using infliximab.