TNF inhibitors appear to induce remission in rheumatoid arthritis
More than half of patients with rheumatoid arthritis who go into remission after treatment with a tumour necrosis factor inhibitor may remain well once the treatment is withdrawn, according to data presented at the American
College of Rheumatology annual meeting held in San Diego, California, last month.
The study compared four commonly used treatment strategies for very early
rheumatoid arthritis in 508 patients: standard disease modifying antirheumatic
drug (DMARD) therapy starting with methotrexate; step-combination therapy
starting with methotrexate and adding in other DMARDs; an initial intensive
combination of methotrexate, sulfasalazine and prednisone; and a combination
of methotrexate and infliximab.
The researchers found that the last two combination strategies were the
most effective at inducing remission, although longer-term data will
be needed to see which of the two was most effective.
Ferdinand Breedveld, professor of rheumatology at the University of Leiden,
the Netherlands, said one of the most exciting new pieces of data involves
77 patients who were taken off infliximab after six months’ remission. “What
we found raises the possibility that anti-TNF therapies are remission-inducing
drugs, because in a year and a half of follow up only 10 had flare ups
and had to go back onto therapy,” he said.
He added that as a whole the study shows that, if the disease is diagnosed
and treated early enough, combination therapies used initially are far
better than sequential monotherapy or a stepped-up approach.
“What it also shows us clearly is that if you don’t reach
treatment goals with methotrexate then just switching to another DMARD
is a waste
of time,” he added. |
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