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Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade.

Publication ,  Journal Article
Smolen, JS; Han, C; van der Heijde, DMFM; Emery, P; Bathon, JM; Keystone, E; Maini, RN; Kalden, JR; Aletaha, D; Baker, D; Han, J; Bala, M ...
Published in: Ann Rheum Dis
June 2009

OBJECTIVE: To examine the association of radiographic progression and disease activity states in patients with rheumatoid arthritis (RA) treated with methotrexate with or without infliximab. METHODS: Patients (n = 1049) with active RA for 3 years or less and no previous methotrexate treatment were randomly assigned (4 : 5 : 5) to receive methotrexate plus placebo or methotrexate plus infliximab 3 or 6 mg/kg at weeks 0, 2 and 6, and every 8 weeks thereafter to week 46. Disease activity was classified by the simplified disease activity index as remission (< or =3.3), low (>3.3 to < or =11), moderate (>11 to < or =26), high (>26). Radiographic progression was measured as a change from baseline to week 54 in total Sharp score. RESULTS: At weeks 14 and 54, more patients receiving methotrexate plus infliximab than methotrexate plus placebo were in remission (10.7% versus 2.8% week 14; 21.3% versus 12.3% week 54; p<0.001 for both). Methotrexate plus placebo halted radiographic progression only if patients achieved remission within 3 months, whereas methotrexate plus infliximab also halted or minimised progression in patients with low or moderate activity, respectively. Patients with persistently high disease activity levels had much less progression of joint damage if treated with methotrexate plus infliximab versus methotrexate monotherapy. Even with infliximab plus methotrexate there was a direct relationship between disease activity and radiographic changes, although the slope was deflected when compared with methotrexate monotherapy. CONCLUSION: With methotrexate, joint damage progresses even at low and moderate disease activity levels, whereas methotrexate plus infliximab inhibits radiographic progression across all disease activity states.

Duke Scholars

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Published In

Ann Rheum Dis

DOI

EISSN

1468-2060

Publication Date

June 2009

Volume

68

Issue

6

Start / End Page

823 / 827

Location

England

Related Subject Headings

  • Tumor Necrosis Factor-alpha
  • Treatment Outcome
  • Remission Induction
  • Middle Aged
  • Methotrexate
  • Male
  • Infliximab
  • Humans
  • Female
  • Drug Therapy, Combination
 

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APA
Chicago
ICMJE
MLA
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Smolen, J. S., Han, C., van der Heijde, D. M. F. M., Emery, P., Bathon, J. M., Keystone, E., … Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group, . (2009). Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade. Ann Rheum Dis, 68(6), 823–827. https://doi.org/10.1136/ard.2008.090019
Smolen, J. S., C. Han, D. M. F. M. van der Heijde, P. Emery, J. M. Bathon, E. Keystone, R. N. Maini, et al. “Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade.Ann Rheum Dis 68, no. 6 (June 2009): 823–27. https://doi.org/10.1136/ard.2008.090019.
Smolen JS, Han C, van der Heijde DMFM, Emery P, Bathon JM, Keystone E, Maini RN, Kalden JR, Aletaha D, Baker D, Han J, Bala M, St Clair EW, Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group. Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade. Ann Rheum Dis. 2009 Jun;68(6):823–827.

Published In

Ann Rheum Dis

DOI

EISSN

1468-2060

Publication Date

June 2009

Volume

68

Issue

6

Start / End Page

823 / 827

Location

England

Related Subject Headings

  • Tumor Necrosis Factor-alpha
  • Treatment Outcome
  • Remission Induction
  • Middle Aged
  • Methotrexate
  • Male
  • Infliximab
  • Humans
  • Female
  • Drug Therapy, Combination