Remicade and Methotrexate as Initial Treatment Can Produce Remission

Initial combination therapy with Remicade (infliximab) and methotrexate can produce a remission in some rheumatoid arthritis patients which may allow them to eventually stop taking medications. Dutch researchers announced the findings at the 70th annual meeting of the American College of Rheumatology underway in Washington, D.C. The results were derived from the long-term BeSt study (named for Dutch words meaning "treatment strategies") which involved 508 patients with early evidence of rheumatoid arthritis. The study abstract is available online. (Presentation number 658)

Study participants were randomized to receive one of four treatment strategies: sequential monotherapy with standard drugs (i.e. one drug used), monotherapy which built up to combination therapy (i.e. more than one drug used), initial combination therapy using prednisone and another drug, or initial combination therapy using Remicade and methotrexate. Results revealed that initial combination therapy was more effective than initial monotherapy with regard to functional ability and decreased x-ray evidence of joint damage but it was Remicade and methotrexate which appeared to produce the most significant results.

After two years, 56 percent of patients (67 of 120) initially treated with Remicade and methotrexate were able to stop Remicade without symptoms returning and begin tapering methotrexate to 10 mg/week. A year later, 15 percent of patients initially treated with Remicade and methotrexate also were able to stop methotrexate and currently remain in remission. Only four of the 67 "responders" had to increase methotrexate and re-start Remicade during the third year following a flare of arthritis symptoms. Future data will determine if joint erosions are continuing in patients which appear to be symptom-free. Not all doctors are convinced that the patients who went into remission would not have gone into remission anyway. Then of course there is the more practical financial concern of being able to treat all patients with a biologic drug and methotrexate. Is it even feasible?

• The Facts of Remicade
• The Facts of Methotrexate
• Rheumatoid Arthritis: Explained With Pictures
• What Defines a Remission in Rheumatoid Arthritis?
• Why is Early Treatment for Rheumatoid Arthritis Important?

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