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Logo of arthrestherBioMed Centralbiomed central web sitesearchsubmit a manuscriptregisterthis articleArthritis Research & Therapy
Arthritis Res Ther. 2006; 8(4): R112.
Published online Jul 17, 2006. doi:  10.1186/ar2001
PMCID: PMC1779428
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 Cruyssen,corresponding author1 Stijn Van Looy,2 Bart Wyns,2 Rene Westhovens,3 Patrick Durez,4 Filip Van den Bosch,1 Herman Mielants,1 Luc De Clerck,5 Ann Peretz,6 Michel Malaise,7 Leon Verbruggen,8 Nathan Vastesaeger,9 Anja Geldhof,10 Luc Boullart,2 and Filip De Keyser1
1Department of Rheumatology, Ghent University Hospital, B-9000 Gent, Belgium
2Department of Electrical Energy, Systems and Automation, Ghent University, Gent, Belgium
3Department of Rheumatology, University Hospitals K.U. Leuven, Leuven, Belgium
4Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
5Department of Rheumatology, University Hospital Antwerp, Antwerp, Belgium
6Department of Rheumatology, University Hospital Brugmann, Brussels, Belgium
7Department of Rheumatology, University Hospital Liège, Liège, Belgium
8Department of Rheumatology, AZ Vrije Universiteit Brussel, Brussels, Belgium
9Department of Medical Affairs, Schering-Plough, Brussels, Belgium
10Department of Medical Affairs, Centocor BV, Leiden, the Netherlands
corresponding authorCorresponding author.
Bert Vander Cruyssen: Bert.VanderCruyssen/at/; Stijn Van Looy: Stijn.VanLooy/at/; Bart Wyns: Bart.Wyns/at/; Rene Westhovens: Rene.Westhovens/at/; Patrick Durez: Patrick.Durez/at/; Filip Van den Bosch: Filip.VanDenBosch/at/; Herman Mielants: Herman.Mielants/at/; Luc De Clerck: Luc.De.Clerck/at/; Ann Peretz: aperetz/at/; Michel Malaise: Michel.Malaise/at/; Leon Verbruggen: Leon.Verbruggen/at/; Nathan Vastesaeger: Nathan.Vastesaeger/at/; Anja Geldhof: ageldhof/at/; Luc Boullart: Luc.Boullart/at/; Filip De Keyser: Filip.DeKeyser/at/
Received March 27, 2006; Revisions requested May 11, 2006; Revised June 12, 2006; Accepted June 29, 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.
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