title: Four-year follow-up of infliximab therapy in rheumatoid arthritis patients with long-standing refractory disease: attrition and long-term evolution of disease activity.
abstract: Although there is strong evidence supporting the short-term efficacy and safety of anti-tumour necrosis factor-alpha agents, few studies have examined the long-term effects. We evaluated 511 patients with long-standing refractory rheumatoid arthritis treated with intravenous infusions of infliximab 3 mg/kg at weeks 0, 2, 6, and 14 and every 8 weeks thereafter for 4 years. Among the initial 511 patients included in the study, 479 could be evaluated; of these, 295 (61.6%) were still receiving infliximab treatment at year 4 of follow-up. The most common reasons for treatment discontinuation were lack of efficacy (65 patients, 13.6%), safety (81 patients, 16.9%), and elective change (38 patients, 7.9%). Analysis of disease activity scores (DAS28 [disease activity score based on the 28-joint count]) over time showed that, after the initial rapid improvement during the first 6 to 22 weeks of therapy, a further decrease in disease activity of 0.2 units in the DAS28 score per year was observed. DAS28 scores, measured at week 14 or 22, were found to predict subsequent discontinuation due to lack of efficacy. In conclusion, long-term maintenance therapy with infliximab 3 mg/kg is effective in producing further reductions in disease activity. Disease activity measured by the DAS28 at week 14 or 22 of infliximab therapy was the best predictor of long-term attrition.
authors.affiliation: Department of Rheumatology, Ghent University Hospital, B-9000 Gent, Belgium. Bert.VanderCruyssen@Ugent.be
authors.forename: Bert
authors.initials: B
authors.lastname: Vander Cruyssen
authors.forename: Stijn
authors.initials: S
authors.lastname: Van Looy
authors.forename: Bart
authors.initials: B
authors.lastname: Wyns
authors.forename: Rene
authors.initials: R
authors.lastname: Westhovens
authors.forename: Patrick
authors.initials: P
authors.lastname: Durez
authors.forename: Filip
authors.initials: F
authors.lastname: Van den Bosch
authors.forename: Herman
authors.initials: H
authors.lastname: Mielants
authors.forename: Luc
authors.initials: L
authors.lastname: De Clerck
authors.forename: Ann
authors.initials: A
authors.lastname: Peretz
authors.forename: Michel
authors.initials: M
authors.lastname: Malaise
authors.forename: Leon
authors.initials: L
authors.lastname: Verbruggen
authors.forename: Nathan
authors.initials: N
authors.lastname: Vastesaeger
authors.forename: Anja
authors.initials: A
authors.lastname: Geldhof
authors.forename: Luc
authors.initials: L
authors.lastname: Boullart
authors.forename: Filip
authors.initials: F
authors.lastname: De Keyser
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006304:Health Status; D006801:Humans; D000069285:Infliximab; D007275:Injections, Intravenous; D008727:Methotrexate / Q000627:therapeutic use; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha; D028761:Withholding Treatment
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D008727:Methotrexate