A randomised comparative study of the short term clinical and biological effects of intravenous pulse methylprednisolone and infliximab in patients with active rheumatoid arthritis despite methotrexate treatment. Issue 9 (12th August 2004)

• Record Type: Journal Article
• Authors: Durez, P; Nzeusseu Toukap, A; Lauwerys, B R; Manicourt, D H; Verschueren, P; Westhovens, R; Devogelaer, J-P; Houssiau, F A
• Is Part Of: Annals of the rheumatic diseases. Volume 63:Issue 9(2004)
• Page Start: 1069
• Page End: 1074
• Publication Date: 2004-08-12
• Subjects: ACR, American College of Rheumatology -- CRP, C reactive protein -- DMARD, disease modifying antirheumatic drug -- IFX, infliximab -- IL, interleukin -- IV, intravenous -- MMP, matrix metalloproteinase -- MP, methylprednisolone -- MTX, methotrexate -- RA, rheumatoid arthritis -- SJC, swollen joint count -- TJC, tender joint count -- TNF, tumour necrosis factor; rheumatoid arthritis -- glucocorticoids -- pulse therapy -- infliximab -- tumour necrosis factor blockade; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/ard.2003.012914
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objectives: To compare the short term clinical and biological effects of intravenous (IV) pulse methylprednisolone (MP) and infliximab (IFX) in patients with severe active rheumatoid arthritis (RA) despite methotrexate (MTX) treatment. Methods: Patients with active RA despite MTX treatment were randomly allocated to receive a single IV infusion of MP (1 g) or three IV infusions of IFX (3 mg/kg) on weeks 0, 2, and 6. Patients were "blindly" evaluated for disease activity measures. Quality of life (QoL) was evaluated through the SF-36 health survey. Serum matrix metalloproteinase-3 (MMP-3) titres were measured at baseline, weeks 2 and 6. Results: Compared with baseline, significant improvement was noted in all activity measures, including serum C reactive protein (CRP) titres, in the IFX group only. At week 14, 6/9 (67%) and 4/9 (44%) IFX patients met the ACR20 and 50 response criteria, while this was the case in only 1/12 (8%) and 0/12 (0%) MP patients, respectively (p<0.05). None of the QoL scales improved with MP treatment, whereas some did so in the IFX group. Serum MMP-3 titres significantly decreased (41% drop) at week 6 in the IFX group, while no changes were seen in patients given MP. Conclusion: This short term randomised comparative study demonstrates that TNF blockade is better than MP pulse therapy in a subset of patients with severe refractory RA, with improvement in not only clinical parameters of disease activity but also biological inflammatory indices, such as serum CRP and MMP-3 titres.