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

OBJECTIVES:

To compare the short term clinical and biological effects of intravenous (i.v.) pulse methylprednisolone (MP) and infliximab (IFX) inpatients 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 i.v. infusion of MP (1 g) or three i.v. 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 ofpatients 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.

Authors: Durez, P. ;Nzeusseu Toukap, A. ;Lauwerys, B. R. ;Manicourt, D. H. ;Verschueren, P. ;Westhovens, R. ;Devogelaer, J. P. ;Houssiau, F. A. 

Title: 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

Year: 2004

Journal: Ann Rheum Dis

Volume: 63

Issue: 9

Pages: 1069-74

Pubmed Link: Click here