Early Infliximab May Put Early Rheumatoid Arthritis Into Remission




By Karla Gale

NEW YORK (Reuters Health) Nov 13 - If started early enough, the rheumatoid arthritis disease-modifying drugs infliximab and methotrexate can halt disease progression, Dutch investigators report this week at the American College of Rheumatology Annual Scientific Meeting in Washington, DC.

Dr. C. F. Allaart, from Leiden University, and her associates have initiated a 4-armed randomized clinical trial. At the meeting, they presented their findings for the arm in which treatment with infliximab 3 mg/kg plus methotrexate 25 mg/week was initiated.

The 120 patients had had symptoms for more than 2 years, Dr. Allart told Reuters Health. They had a baseline Disease Activity Score of 4.3, 64% were positive for rheumatoid factor, and 73% had erosions.

When the Disease Activity Score fell to less than 2.4 for at least 6 months, infliximab was tapered down and discontinued and then methotrexate dose was lowered to 10 mg/week. In the 3rd year, if the disease activity score was less than 1.6 for at least 6 months, methotrexate was tapered down and discontinued.

If Disease Activity Scores began to rise again, the physicians restarted therapy, first with methotrexate, and then with infliximab if necessary.

After 2 years, 63 patients had responded to treatment, as demonstrated by their discontinuation of infliximab without relapse and lowered dose of methotrexate to an average of 12.6 mg/week. Twenty-three continued treatment, and 30 patients had failed and were switched to other treatments.

After 3 years, 61 of the responders had not relapsed, and 16 were taking no anti-rheumatic therapy at all. Only four had to restart infliximab treatment after a median of 22.5 months after discontinuation. Of the 23 who continued treatment, three were able to stop infliximab.

"These findings indicate that initial treatment with methotrexate plus infliximab may alter the course of early RA," the investigators conclude in their meeting abstract.

"So far, there has only been one published study of early treatment of RA with infliximab," Dr. Allart said. "But ours is the largest." She suggests that early in the course of disease, the disease-modifying agents can still "debulk" the inflammatory tissue, while enough healthy tissue remains to halt disease progression.