�Half of patients with early rheumatoid arthritis treated with the anti-tumour mortification factor inhibitor (anti-TNF) infliximab plus amethopterin achieve remission, and up to one in cinque achieve drug-free remission, according to five-year follow-up results from the BeSt C154% charge per unit over clock time was most twice as high with infliximab (odds ratio 1.97; p=0.04). Sustained remission was achieved in 31% of the FIN-RACo group, and 40% of the patients also treated with remicade.
Radiological progression was besides better with the remicade combination. Just over half (54%) had a Sharp/van der Heijde score (SHS) - a measure of joint damage on X-ray - of 0 at two years, compared to 41% of patients toughened with the FIN-RACo. The mean change of SHS over the two long time was 1.4 in patients treated with FIN-RACo, compared to -0.2 in those also treated with infliximab (p=0.005).
The enquiry group, light-emitting diode by M. Leirisalo-Repo, from Helsinki University Central Hospital, Helsinki, Finland, said: "Adding infliximab to intensive use of FIN-RACo in early active RA during the first hexad months reflected in higher frequencies of remissions over time and prevented radiological progression during two years."4
Initial combination therapy prevents os loss in RA Initial combination therapy with remicade or deltasone is associated with less reduction in bone mineral density (BMD) in the hand than other treatment strategies, show further results from the BeSt Study.
The Dutch study randomised 508 patients with recent onset, active RA to sequential monotherapy or come out combination therapy, both starting with amethopterin, combination therapy with a tapered high dose of prednisone, sulphasalazine and amethopterin, or remicade plus methotrexate. Bone density was calculated by digital X-ray radiogrammetry in both hands, in the rosehip and spinal column in 218 patients, at baseline and after one and two years.
Results showed significantly greater BMD loss in the work force (-2.5%) at deuce years, than in the hip (-0.5%) and spine (-1.0%), indicating that it provides a useful measure over a relatively short time period of time. Initial combination therapy with infliximab or prednisone was associated with less hand BMD loss than initial monotherapies ( -1.6% with infliximab combination therapy and -1.4% with prednisone-based treatment vs -3.6% with sequential monotherapy and -3.3% with come forward combination therapy).
Progression of erosions was independently associated with increased BMD loss in the hands and hip later one year.
The research group, from Leiden University Medical Center, Leiden; Haga Hospital, the Hague, and VU Medical Center, Amsterdam, the Netherlands, commented: "Initial combination therapy with remicade or prednisone is associated with less hand BMD loss due to more rapid, equal suppression of disease activity compared to initial monotherapy." They added: "The association between progressive joint legal injury and both hand and hip BMD loss suggests common pathways between these processes in RA."5
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References1. Klarenbeek, NB, G�ler-Y�ksel M, van der Kooij SM, van der Heijde DMFM, Huizinga TWJ, Kerstens PJSM, Peeters AJ, Ronday HK, Westedt ML, Dijkmans BAC, Allaart CF. Clinical Outcomes Of Four Different Treatment Strategies In Patients With Recent-Onset Rheumatoid Arthritis: 5-Years Results Of The BEST-Study. EULAR 2008: Abstract [THU0162]
2. van Vollenhoven RF, Ernestam S, Geborek P, Petersson IF, C�ster L, Waltbrand E, Zickert A, Theander J, Th�rner A, Hellstr�m H, Teleman A, Dackhammar C, Akre F, Forslind K, Ljung L, Oding R, W�rnert M, Bratt J. In Patients With Early RA Who Failed Initial MTX, The Addition Of Anti-TNF Yields Better EULAR And ACR Responses Than The Addition Of Conventional DMARDs: 1-Year Results Of The SWEFOT Clinical Trial. EULAR 2008: Abstract [LB0001]
3. Pocock JM, Ost�r AJK. Anti-TNF Efficacy in Rheumatoid Arthritis - Three or Six Month Trial. EULAR 2008: Abstract [FRI0131]
4. Leirisalo-Repo M, Kautiainen H, Laasonen L, M�tt�nen T, Hannonen P, Korpela M, Kauppi M, Kaipiainen-Sepp�nen O, Luosuj�rvi R, Bl�field H, Ilva K, Julkunen H, Uutela T, Moilanen E. A Randomized, Double-Blind, Placebo-Controlled Study On Addition Of Infliximab To The FIN-RACO DMARD Combination Therapy For Initial Six Months In Patients With Early Active Rheumatoid Arthritis. The NEO-RACO Study. EULAR 2008: Abstract [OP-0009]
5. G�ler-Y�ksel M, Allaart CF, Huizinga TWJ, de Beus WM, Ewals JAPM, Hulsmans HMJ, Dijkmans BAC, Lems WF. Initial Combination Therapy Prevents Bone Mineral Density (BMD) Loss In The Hands In Patients With Recent-Onset Rheumatoid Arthritis (RA) EULAR: Abstract [OP-0029]
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