Infliximab is Associated with Improvement in Arterial Stiffness in Patients with Early Rheumatoid Arthritis — A Randomized Trial

To determine the efficacy of methotrexate (MTX) with infliximab (IFX) compared with MTX alone in the prevention of atherosclerosis and arterial stiffness in patients with early rheumatoid arthritis (RA). A randomized, open-label study in which early RA patients with active disease were treated with...

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Bibliographic Details
Published in:Journal of rheumatology 2012-12, Vol.39 (12), p.2267-2275
Main Authors: TAM, Lai-Shan, QING SHANG, LEUNG, Moon-Ho, MARTIN LI, LI, Tena K, ZHU, Tracy Y, CHUI, Ricky K, TSEUNG, Lorraine, YU, Shui-Lian, KUAN, Woon-Pang, YU, Cheuk-Man, LI, Edmund K, SHANG WANG, LI, Rui-Jie, LEE, Ka-Lai, LEUNG, Ying-Ying, YING, King-Yee, YIM, Cheuk-Wan, KUN, Emily W
Format: Article
Language:English
Subjects:
Adult
Antibodies, Monoclonal - therapeutic use
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - physiopathology
Atherosclerosis - diagnosis
Atherosclerosis - prevention & control
Biological and medical sciences
Blood Flow Velocity - drug effects
Bones, joints and connective tissue. Antiinflammatory agents
Carotid Intima-Media Thickness
Diseases of the osteoarticular system
Drug Substitution
Drug Therapy, Combination
Female
Health Status
Humans
Immunomodulators
Inflammatory joint diseases
Infliximab
Joints - drug effects
Joints - pathology
Joints - physiopathology
Male
Medical sciences
Methotrexate - therapeutic use
Middle Aged
Pharmacology. Drug treatments
Pulse Wave Analysis
Severity of Illness Index
Treatment Failure
Vascular Stiffness - drug effects
Vascular Stiffness - physiology
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Summary:To determine the efficacy of methotrexate (MTX) with infliximab (IFX) compared with MTX alone in the prevention of atherosclerosis and arterial stiffness in patients with early rheumatoid arthritis (RA). A randomized, open-label study in which early RA patients with active disease were treated with MTX alone (n = 20) and MTX plus IFX (n = 20) for 6 months. Patients were assessed every 3 months. Patients from the MTX-alone group who failed to achieve 28-joint Disease Activity Score remission (DAS28 ≤ 2.6) at 6 months were permitted to escape to open-label IFX. Intima-media thickness (IMT), pulse wave velocity (PWV), and augmentation index (AIx) were measured at baseline, 6 months, and 12 months. At 6 months, there was a significantly greater reduction in PWV in the MTX-alone group (0.18 ± 1.59 m/s) compared with the MTX plus IFX group (-0.78 ± 1.13 m/s; p = 0.044), accompanied by significantly greater reduction in patient's global assessment, number of swollen joints, C-reactive protein, and DAS28 in the MTX plus IFX group compared to the MTX-alone group. The changes in IMT and AIx were similar between the 2 groups. At 12 months, there was a trend favoring early combination treatment with regard to the reduction in PWV (p = 0.06). MTX plus IFX causes a more significant reduction in PWV than MTX alone in patients with early RA after 6-month treatment, and further improvement may be achieved in patients who continued on longterm tumor necrosis factor-α blockers, suggesting that early, effective suppression of inflammation may prevent progression of atherosclerosis by improving vascular function.
ISSN:0315-162X
1499-2752
DOI:10.3899/jrheum.120541