Remicade Mtx


Drug Mix Halts Joint Erosion In Persistent Arthritis

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

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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