Infliximab leads to a rapid but transient improvement in endothelial function in patients with primary systemic vasculitis.
OBJECTIVE
To assess the immediate effects of tumour necrosis factor alpha (TNFalpha) blockade on endothelial function in systemic vasculitis.


METHODS
Endothelial function was assessed by laser Doppler flowmetry in patients with active vasculitis after 10 infusions of infliximab. For comparison endothelial responses were assessed after five infusions of cyclophosphamide plus methylprednisolone.


RESULTS
Endothelial dependent vasodilatation (EDV) improved significantly within 24 hours of infliximab infusion. The median change in red blood cell flux (interquartile range) was 5.7 (4.3-8.2) before infusion v 8.4 (7.5-10.9) at 24 hours; p=0.027. This was not maintained at day 14. No improvement was seen in EDV after cyclophosphamide plus methylprednisolone infusion.


CONCLUSIONS
The rapid but transient improvement in EDV after TNFalpha inhibition suggests that TNFalpha may have a direct role in the impairment of endothelial function.
Raza
K
K
Rheumatology Research Group, Division of Immunity and Infection, The Medical School, The University of Birmingham, and Department of Rheumatology, City Hospital, UK.
Carruthers
D M
DM
Stevens
R
R
Filer
A D
AD
Townend
J N
JN
Bacon
P A
PA
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001167:Arteritis / Q000188:drug therapy* / Q000276:immunology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000276:immunology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D017078:Laser-Doppler Flowmetry; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010865:Pilot Projects; D018709:Statistics, Nonparametric; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D003520:Cyclophosphamide; D000069285:Infliximab; D008775:Methylprednisolone