Remicade Mtx
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Drug Mix Halts Joint Erosion In Persistent Arthritis NEJM 11/30/2000 By Anne MacLennan Repeated doses of infliximab(Remicade) combined with methotrexate reduces the symptoms of rheumatoid arthritis and also halt progression of joint damage in patients who do not respond to methotrexate therapy, a study has found. Neutralization of tumor necrosis factor alpha (TNF-alpha) for three to six months is known to reduce symptoms and signs of rheumatoid arthritis. However, the capacity of this approach to achieve a more sustained benefit-and its effect on joint damage-has been unknown. Participants in this trial were 428 patients with active rheumatoid arthritis despite methotrexate therapy. For 54 weeks, they were treated with placebo or infliximab, a chimeric monoclonal antibody against TNF-alpha, in intravenous doses of three or 10 mg per kilogram of body weight every four or eight weeks in combination with oral methotrexate. Clinical responses were assessed according to American College of Rheumatology criteria, quality of life with a health-status questionnaire and effect on joint damage radiographically. The infliximab/methotrexate combination was well tolerated and produced a significantly greater reduction in symptoms and signs of rheumatoid arthritis than did methotrexate therapy alone. Quality of life was also significantly better with the combination than the methotrexate alone. Furthermore, while radiographic evidence of joint damage increased in those taking methotrexate alone, it did not in the combined-therapy groups. Whether or not they had a clinical response to therapy, infliximab-treated patients showed no radiographic evidence of progression of joint damage. A comment suggests it is now reasonable to argue that TNF-alpha inhibitors should be used as early as possible in all patients with documented rheumatoid arthritis. The comment refers to evidence in both this and a related study [See Etanercept Curbs Early Rheumatoid Arthritis-vis A Comparison of Etanercept and Methotrexate in Patients with Early Rheumatoid Arthritis]. N Engl J Med 2000;343:1594-602
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