Addition of Remicade to MTX

Addition Of Infliximab To Methotrexate Benefits Patients With Rheumatoid Arthritis

WESTPORT, Dec 03 (Reuters Health) - Rheumatoid arthritis patients who do not respond to methotrexate monotherapy improve with the addition of infliximab, an inhibitor of tumor necrosis factor-alpha, researchers report for the ATTRACT Study Group.

Dr. Ravinder N. Maini, of Charing Cross Hospital in London, UK, and a multinational team recruited 428 patients with active rheumatoid arthritis who had been taking methotrexate for at least 3 months and had been at a stable dose for at least 4 weeks.

In a double-blind trial, the patients were randomized to receive either a placebo or one of four treatment regimens of infliximab, in addition to a stable dose of methotrexate. The team evaluated the patients every 4 weeks for 30 weeks.

Among patients receiving 3 mg/kg of infliximab, 53% improved at least 20% over baseline if subsequent doses were given every 4 weeks, and 50% improved if later doses were given every 8 weeks.

Among patients receiving 10 mg/kg of infliximab, 58% improved at least 20% over baseline on additional doses every 4 weeks, while 52% improved on doses every 8 weeks. Only 20% of the placebo group improved by 20% over baseline.

The improvements with infliximab were all significantly better than those with placebo, according to the report. The antibody was tolerated well, and adverse events occurred equally often in the placebo and infliximab groups.

Although combination infliximab and methotrexate therapy was proven effective in these patients, "[t]he cost effectiveness of anti-tumour necrosis factor therapy must also await longer term data evaluating the cost of this therapy and the improvement in the quality of life that might follow, set against the cumulative social and healthcare costs of current therapies," the authors write in the December 4th issue of The Lancet.

Lancet 1999;354:1932-1939.

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