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Four-year follow-up of infliximab therapy in rheumatoid arthritis patients with long-standing refractory disease: attrition and long-term evolution of disease activity

Bert Vander Cruyssen1*, Stijn Van Looy2, Bart Wyns2, Rene Westhovens3, Patrick Durez4, Filip Van den Bosch1, Herman Mielants1, Luc De Clerck5, Ann Peretz6, Michel Malaise7, Leon Verbruggen8, Nathan Vastesaeger9, Anja Geldhof10, Luc Boullart2 and Filip De Keyser1

Author Affiliations

1 Department of Rheumatology, Ghent University Hospital, B-9000 Gent, Belgium

2 Department of Electrical Energy, Systems and Automation, Ghent University, Gent, Belgium

3 Department of Rheumatology, University Hospitals K.U. Leuven, Leuven, Belgium

4 Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium

5 Department of Rheumatology, University Hospital Antwerp, Antwerp, Belgium

6 Department of Rheumatology, University Hospital Brugmann, Brussels, Belgium

7 Department of Rheumatology, University Hospital Liège, Liège, Belgium

8 Department of Rheumatology, AZ Vrije Universiteit Brussel, Brussels, Belgium

9 Department of Medical Affairs, Schering-Plough, Brussels, Belgium

10 Department of Medical Affairs, Centocor BV, Leiden, the Netherlands

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Arthritis Research & Therapy 2006, 8:R112  doi:10.1186/ar2001

Published: 17 July 2006


Although there is strong evidence supporting the short-term efficacy and safety of anti-tumour necrosis factor-α agents, few studies have examined the long-term effects. We evaluated 511 patients with long-standing refractory rheumatoid arthritis treated with intravenous infusions of infliximab 3 mg/kg at weeks 0, 2, 6, and 14 and every 8 weeks thereafter for 4 years. Among the initial 511 patients included in the study, 479 could be evaluated; of these, 295 (61.6%) were still receiving infliximab treatment at year 4 of follow-up. The most common reasons for treatment discontinuation were lack of efficacy (65 patients, 13.6%), safety (81 patients, 16.9%), and elective change (38 patients, 7.9%). Analysis of disease activity scores (DAS28 [disease activity score based on the 28-joint count]) over time showed that, after the initial rapid improvement during the first 6 to 22 weeks of therapy, a further decrease in disease activity of 0.2 units in the DAS28 score per year was observed. DAS28 scores, measured at week 14 or 22, were found to predict subsequent discontinuation due to lack of efficacy. In conclusion, long-term maintenance therapy with infliximab 3 mg/kg is effective in producing further reductions in disease activity. Disease activity measured by the DAS28 at week 14 or 22 of infliximab therapy was the best predictor of long-term attrition.