In patients with recent onset rheumatoid arthritis (RA), the initial use of combination therapy with infliximab leads to faster symptom improvements than do other approaches, Dutch researchers report in the January issue of Arthritis and Rheumatism.
Principal investigator Dr. Cornelia F. Allaart told Reuters Health: "Patients with newly diagnosed RA can be...optimistic about their future, with a high chance of a good response on combination therapy and a high chance of medication reduction. If that happens -- even remission and discontinuation of all drugs is a real possibility."
Dr. Allaart and colleagues at Leiden University Medical Center studied 508 patients with recent-onset RA who were randomized to four different treatment approaches.
The first group received sequential monotherapy starting with methotrexate and ending up with methotrexate and infliximab; the second group also started methotrexate monotherapy followed by combination therapy with methotrexate and infliximab; the third group began with combination therapy including tapered high-dose prednisone; and the last group began with combination therapy with methotrexate and infliximab.
Every 3 months, the patients' response was evaluated and treatment was adjusted. "Patients with RA need to be treated based on regular measurements of the disease activity, with treatment adjustments aimed at achieving a low disease activity," Dr. Allaart pointed out.
After 2 years, all of the patients reported significant improvements from baseline in outcome measures and approached or reached population norms in categories such as bodily pain.
However, based on comparison of the four treatment arms after 3 months, improvement in functioning, visual analogue disease activity scores and disability questionnaire responses occurred significantly earlier in the two groups of patients who had started with combination therapy.
Dr. Allaart concluded that "infliximab as initial treatment gives a better chance of a speedy improvement in symptoms, persistent suppression of joint damage progression, and on tapering and discontinuation of the drug, than infliximab as rescue treatment after conventional antirheumatic drugs have failed."
In comments to Reuters Health, co-author of an accompanying editorial, Dr. John Kirwan of the University of Bristol, UK, pointed out that one advance by the researchers was that "they sought to express the benefits of particular treatments for arthritis in terms that can be easily understood by the patient, rather than in scientific jargon that is meaningless to the average person."
"This," he concluded, "reflects an increasing recognition of the importance of patient-reported outcomes which show what impact the disease and its treatment have on daily life."
Arthritis Care Res 2009;61:4-12.