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Infliximab Appears to Inhibit Joint Destruction in Patients With Psoriatic Arthritis: Presented at EULAR

By Jerry Ingram

VIENNA, AUSTRIA -- June 15, 2005 -- Treatment with the antitumor necrosis factor blocker, infliximab (Remicade) might result in significantly greater inhibition of structural damage compared with placebo in patients with psoriatic arthritis, according to phase 3 data from the Induction and Maintenance Psoriatic Arthritis Clinical Trial 2 (IMPACT 2).

"Inhibiting the progression of joint destruction is vital in the management and treatment of patients with psoriatic arthritis," explained investigator Désirée van der Heijde, MD, PhD, professor of rheumatology, University of Maastricht, Maastricht, the Netherlands.

Dr. van der Heijde presented the data here on June 10^th at the EULAR 2005, the European Congress of Rheumatology.

Although it is unclear precisely how one should interpret negative score changes, radiographic evidence clearly illustrates that more patients experienced no worsening of joint destruction in the infliximab group compared with the placebo group, Dr. van der Heijde added.

For their double-blind, placebo-controlled trial, Dr. van der Heijde and colleagues enrolled 200 patients who had active psoriatic arthritis. Patients were randomized in a 1:1 ratio to receive placebo or infliximab 5 mg/kg at weeks 0, 2, 6, 14, and 22. Investigators obtained radiographs of patients' hands and feet at baseline and at 24 weeks.

Two independent radiologists evaluated erosions and joint space narrowing using the van der Heijde-Sharp method, which was modified for psoriatic arthritis by including distal interphalangeal joints of the hands (range 0 to 528).

At week 24, the radiographs showed significantly less progression of structural damage among infliximab-treated subjects than among placebo subjects. They found that the mean change from baseline in patients receiving infliximab was a decrease of -0.70 score, compared with an increase of 0.82 score in the placebo group (P < 0.001). Results were comparable when they assessed separately the radiographs of hands (P <.001), feet (P =.003), erosions (P <.001), and joint space narrowing (P =.013).

In the placebo group, 11 patients showed progression above the smallest detectable difference (SDD=3.8) compared with 1 patient in the infliximab group. However, researchers observed no differences between the treatment groups in psoriatic arthritis-specific radiographic features, including pencil-in-cup deformities and gross osteolysis.

Dr. van der Heijde concluded that infliximab treatment appears to inhibit radiographic progression in this patient population in addition to reducing the signs and symptoms associated with psoriatic arthritis.

This study was funded by Centocor.


[Presentation title: Infliximab Inhibits Progression of Radiographic Damage in Patients With Active Psoriatic Arthritis: Results from IMPACT 2 Trial. Abstract OP0169]

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