Four-year follow-up of infliximab therapy in rheumatoid arthritis patients with long-standing refractory disease: attrition and long-term evolution of disease activity.
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.
Vander Cruyssen
Bert
B
Department of Rheumatology, Ghent University Hospital, B-9000 Gent, Belgium. Bert.VanderCruyssen@Ugent.be
Van Looy
Stijn
S
Wyns
Bart
B
Westhovens
Rene
R
Durez
Patrick
P
Van den Bosch
Filip
F
Mielants
Herman
H
De Clerck
Luc
L
Peretz
Ann
A
Malaise
Michel
M
Verbruggen
Leon
L
Vastesaeger
Nathan
N
Geldhof
Anja
A
Boullart
Luc
L
De Keyser
Filip
F
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
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D008727:Methotrexate