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
Identifieur interne : 001901 ( Main/Exploration ); précédent : 001900; suivant : 001902A 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
Auteurs : P. Durez [Belgique] ; A. Nzeusseu Toukap [Belgique] ; B R Lauwerys [Belgique] ; D H Manicourt [Belgique] ; P. Verschueren [Belgique] ; R. Westhovens [Belgique] ; J-P Devogelaer [Belgique] ; F A Houssiau [Belgique]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2004-09.
English descriptors
- KwdEn :
- 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, glucocorticoids, infliximab, pulse therapy, rheumatoid arthritis, tumour necrosis factor blockade.
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.
Url:
DOI: 10.1136/ard.2003.012914
Affiliations:
- Belgique
- Province du Brabant wallon, Région wallonne
- Louvain-la-Neuve
- Université catholique de Louvain
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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.</div></front></TEI><affiliations><list><country><li>Belgique</li></country><region><li>Province du Brabant wallon</li><li>Région wallonne</li></region><settlement><li>Louvain-la-Neuve</li></settlement><orgName><li>Université catholique de Louvain</li></orgName></list><tree><country name="Belgique"><region name="Région wallonne"><name sortKey="Durez, P" sort="Durez, P" uniqKey="Durez P" first="P" last="Durez">P. Durez</name></region><name sortKey="Devogelaer, J P" sort="Devogelaer, J P" uniqKey="Devogelaer J" first="J-P" last="Devogelaer">J-P Devogelaer</name><name sortKey="Houssiau, F A" sort="Houssiau, F A" uniqKey="Houssiau F" first="F A" last="Houssiau">F A Houssiau</name><name sortKey="Lauwerys, B R" sort="Lauwerys, B R" uniqKey="Lauwerys B" first="B R" last="Lauwerys">B R Lauwerys</name><name sortKey="Manicourt, D H" sort="Manicourt, D H" uniqKey="Manicourt D" first="D H" last="Manicourt">D H Manicourt</name><name sortKey="Nzeusseu Toukap, A" sort="Nzeusseu Toukap, A" uniqKey="Nzeusseu Toukap A" first="A" last="Nzeusseu Toukap">A. Nzeusseu Toukap</name><name sortKey="Verschueren, P" sort="Verschueren, P" uniqKey="Verschueren P" first="P" last="Verschueren">P. Verschueren</name><name sortKey="Westhovens, R" sort="Westhovens, R" uniqKey="Westhovens R" first="R" last="Westhovens">R. Westhovens</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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