title: Infliximab and methotrexate as induction therapy in patients with early rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate the efficacy of infliximab plus methotrexate (MTX) as induction therapy in patients with early rheumatoid arthritis (RA).
  
  
  METHODS
  Disease-modifying antirheumatic drug (DMARD)-naive patients with active, early RA who were included as group 4 of the BeSt study were initially treated with infliximab (3 mg/kg) in combination with MTX (25 mg/week). The Disease Activity Score (DAS) was measured every 3 months. In patients with persistent low disease activity (DAS <or=2.4) for at least 6 months, the infliximab dosage was tapered and finally discontinued; the MTX dosage then was tapered to 10 mg/week. In patients with a DAS of >2.4, the infliximab dosage was increased (maximum 10 mg/kg), and they were subsequently switched to another DMARD. Except for intraarticular administration, corticosteroids were not permitted. Functional ability and the modified Sharp/van der Heijde score were determined after 2 years of therapy.
  
  
  RESULTS
  Of the 120 patients, 67 responders (56%) had persistent low disease activity and discontinued infliximab after a median of 9.9 months, with a median MTX dosage of 10 mg/week after 2 years. Ten other patients experienced a disease flare after discontinuation and resumed infliximab after a median of 3.7 months. Thirteen patients did not achieve persistent low disease activity and received infliximab at various dosages. Treatment was unsuccessful in 30 patients. In the 67 responders, the progression of joint damage was lower than in the 30 patients in whom treatment failed.
  
  
  CONCLUSIONS
  Fifty-six percent of patients with active early RA, initially treated with infliximab plus MTX, could discontinue infliximab after achieving a DAS of <or=2.4. Low disease activity was maintained in these patients while the MTX dosage was tapered to 10 mg/week.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands. a.e.van_der_bijl@lumc.nl
authors.forename: A E
authors.initials: AE
authors.lastname: van der Bijl
authors.forename: Y P M
authors.initials: YP
authors.lastname: Goekoop-Ruiterman
authors.forename: J K
authors.initials: JK
authors.lastname: de Vries-Bouwstra
authors.forename: S
authors.initials: S
authors.lastname: Ten Wolde
authors.forename: K H
authors.initials: KH
authors.lastname: Han
authors.forename: M V
authors.initials: MV
authors.lastname: van Krugten
authors.forename: C F
authors.initials: CF
authors.lastname: Allaart
authors.forename: F C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D011859:Radiography; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D000069285:Infliximab; D008727:Methotrexate