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Increasing Infliximab Dose May Not Benefit Patients with Rheumatoid Arthritis
A DGReview of :"Dose escalation of infliximab in clinical practice: improvements seen may be explained by a regression-like effect"
Annals of the Rheumatic Diseases (ARD Online)
04/02/2004
By Jill Taylor
Dose increases of infliximab for the treatment of rheumatoid arthritis (RA) may not yield the clinical benefit expected, Swedish researchers have found.
Rheumatologists often increase infliximab dosage in cases of inadequate response to the original dose or short-lived treatment effect. However, dose escalation significantly increases treatment cost and clinical improvement has not been demonstrated.
Using data from the Stockholm TNF-alpha follow-up registry (STURE), Ronald F. van Vollenhoven, MD, PhD, and colleagues of the Department of Rheumatology, Karolinska Hospital, Stockholm, performed a study to determine whether an infliximab dose above 3 mg/kg/infusion results in better clinical outcome in rheumatic diseases.
The researchers compared clinical outcomes in 3 groups: 44 patients with RA whose infliximab doses were increased to 5 to 7 mg/kg/infusion, 44 patients treated with infliximab without dose increases, and 36 patients treated with etanercept.
Analysis showed the average disease activity score (DAS28), swollen joint count, and numerical American College of Rheumatology responses significantly improved after dose increase, but the magnitude of improvement was modest. Furthermore, the values after dose increase were similar to the best results obtained previous to dose increase.
In addition, DAS28 and swollen joint count values in each group showed the same pattern of worsening and subsequent improvement with or without infliximab dose increase, with numerically similar changes in outcome that were not statistically different.
Dr. van Vollenhoven and colleagues note that during informal case review, they found a tendency among treating physicians to assess the results of infliximab dose escalation as better than was warranted by outcome, and that dose increases were rarely reversed when no improvement was observed.
"We recommend that formal studies of infliximab dose escalation be undertaken and that individual physicians wishing to increase infliximab dosage do so under very clearly prespecified conditions of follow up," they concluded.
Ann Rheum Dis 2004 Apr;63:4:426-30.
"Dose escalation of infliximab in clinical practice: improvements seen may be explained by a regression-like effect"
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