Infliximab, Steroids Offer Similar RA Remission Rates

August 28, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Aug 28 - In patients with new-onset rheumatoid arthritis (RA), remission induction rates are similar with infliximab and high-dose intravenous steroids, according to results from the IDEA study.

Dr. Paul Emery from University of Leeds, UK and colleagues compared the efficacy of infliximab and intravenous steroid therapy, both in combination with methotrexate, as remission induction in DMARD-na�ve early rheumatoid arthritis, followed by a treat-to-target approach.

They point out that numerous studies have established the value of biologic therapies in patients who fail disease modifying antirheumatic drugs (DMARDs), but few studies have looked at their role in remission induction for DMARD-na�ve disease.

The 18-month randomized, double-blind study included 112 patients.

At week 50 (the primary endpoint), mean changes in modified total Sharp score (mTSS) did not differ between the infliximab (1.20) and intravenous steroid (2.81) groups (p=0.132), according to the August 11th Annals of the Rheumatic Diseases online report.

By week 78, there was no radiographic progression (mTSS change less than 0.5) in 61.9% of infliximab patients and 46.7% of steroid patients (p=0.116).

The proportions of patients achieving DAS44 remission and sustained remission and the time to sustained remission did not differ significantly between the treatment groups.

About a quarter of the infliximab group stopped infliximab due to sustained remission (>6 months), and 78.6% of those maintained remission throughout the rest of the study period.

Similar proportions of patients in the infliximab (46.2%) and intravenous steroid (50.1%) groups achieved an ACR70 response by week 78.

Quality of life improvements and maintenance of employment rates were similar with the two treatments.

Most patients in both groups reported adverse events during the study, but the adverse event rate was higher for the infliximab group than for the steroid group (25.3 vs 11.0 adverse events/100 patient-years). The infliximab group also had a higher rate of serious adverse events (23.6% vs 15.8%).

Both approaches "resulted in good disease control with little structural damage," the researchers conclude. "Comparing longer-term outcomes between these two treatment strategies will be of particular interest and may refine conclusions drawn from the study thus far."

Despite these general conclusions, Dr. Emery said he favors infliximab, "as it acts faster and was better for us." He would especially favor infliximab over high-dose intravenous steroids "where it is reimbursed."

SOURCE: http://bit.ly/1491iIO

Ann Rheum Dis 2013.

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