Source: DGNews  |  Posted 7 years ago

By Jerry Ingram

NEW ORLEANS, LA -- February 22, 2005 -- Remicade (infliximab) appears to significantly reduce the severity of two conditions associated with psoriatic arthritis, according to results of the IMPACT 2 trial.

Approximately one-third of patients with psoriatic arthritis experience dactylitis, a painful swelling of the entire digit in the hands or feet, and enthesopathy, an inflammation of a tendon or ligament insertion to the bone. Only limited options exist for treatment of these painful conditions.

Arthur Kavanaugh, MD, Associate Professor of Medicine, Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, and Director, UCSD Center for Innovative Therapy, San Diego, California, United States, presented the findings here on February 21[^]st[] at the 63[^]rd[] Annual Meeting of the American Academy of Dermatology.

For this multicenter, double-blind, randomized phase III trial, researchers evaluated the efficacy of infliximab in psoriatic arthritis, including the effect on dactylitis and enthesopathy, in 200 patients with active, polyarticular psoriatic arthritis.

Study participants had symptoms for at least 6 months with at least five swollen and tender joints, and had failed to respond to disease disease-modifying antirheumatic drugs or nonsteroidal anti-inflammatory drugs. Clinicians randomized patients to either infliximab 5 mg/kg or placebo at weeks 0, 2, 6, 14, and 22.

Researchers assessed the presence and severity of dactylitis for each digit in both the hand s and feet (0 for no dactylitis and 3 for severe dactylitis), with a total score that could range from 0 to 60. They also evaluated enthesopathy in the feet. Patients had at least one dactylitis digit at baseline

Researchers established two endpoints for the trial -- improvement in dactylitis severity score and proportion of patients with dactylitis and enthesopathy.

Patients in the infliximab group experienced a significant improvement in dactylitis severity score compared with those in the placebo group at weeks 14 and 24 (P =.29 and P <.01). Also, the proportion of patients in the infliximab group with dactylitis was also significantly reduced when compared with the placebo group (18.2% versus 30.9% at week 14 [P =.25] and 11.8% versus 34.0% at week 24 [P <.01]).

In terms of enthesopathy at baseline, 42.0% of patients in the infliximab group had enthesopathy and 35.0% in the placebo group. Investigators reported significant reduction of enthesopathy among patients in the infliximab group compared with placebo both at weeks 14 and 24 (22.2% and 20.4% in the infliximab group and 33.7% at week 14 in the placebo group [P =.16] and 37.2% at week 24 [P =.02]).

Infliximab appears to reduce significantly both the severity and the number of digits affected by dactylitis in patients with psoriatic arthritis and also improves enthesopathy, the researchers concluded.

[Presentation title: Efficacy of Infliximab in Psoriatic Arthritis-Related Dactylitis and Enthesopathy: Results from the IMPACT 2 Trial. Poster 2749]