Infliximab is associated with improvement in arterial stiffness in patients with early rheumatoid arthritis -- a randomized trial.

Abstract

OBJECTIVE:

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).

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

• Authors: Lai-Shan Tam, Qing Shang, Edmund K Li, Shang Wang, Rui-Jie Li, Ka-Lai Lee, Ying-Ying Leung, King-Yee Ying, Cheuk-Wan Yim, Emily W Kun, Moon-Ho Leung, Martin Li, Tena K Li, Tracy Y Zhu, Ricky K Chui, Lorraine Tseung, Shui-Lian Yu, Woon-Pang Kuan, Cheuk-Man Yu
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 39 Issue 12 Pg. 2267-75 (Dec 2012) ISSN: 0315-162X [Print] Canada
• PMID: 22984272 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antirheumatic Agents
• Infliximab
• Methotrexate

Topics

• Adult
• Antibodies, Monoclonal (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (complications, drug therapy, physiopathology)
• Atherosclerosis (diagnosis, prevention & control)
• Blood Flow Velocity (drug effects)
• Carotid Intima-Media Thickness
• Drug Substitution
• Drug Therapy, Combination
• Female
• Health Status
• Humans
• Infliximab
• Joints (drug effects, pathology, physiopathology)
• Male
• Methotrexate (therapeutic use)
• Middle Aged
• Pulse Wave Analysis
• Severity of Illness Index
• Treatment Failure
• Vascular Stiffness (drug effects, physiology)