Article Text
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.
- 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
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- 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