Infliximab is Associated with Improvement in Arterial Stiffness in Patients with Early Rheumatoid Arthritis — A Randomized Trial

Abstract

MTX plus IFX causes a more significant reduction in PWV than MTX alone in patients with early RA after 6-month treatment, and further improvement may be achieved in patients who continued on longterm tumor necrosis factor-α blockers, suggesting that early, effective suppression of inflammation may prevent progression of atherosclerosis by improving vascular function.

Targeting inflammation in the prevention of cardiovascular disease in patients with inflammatory arthritis

“…121 The effect of anti-TNF treatment on PWV had been summarized in a recently published systematic review. 122 Two RCTs in patients with early RA (ERA) 123 and AS 124 both reported more favorable results in the anti-TNF-treated groups (ERA, significantly greater PWV reduction in the IFX 1 MTX group than in MTX alone group; AS, PWV remained stable in the GOL group vs significant progression in the placebo group) ( Table I). Observational and case-control studies reported that the PWV either decrease significantly 31,127,140,144 or remained unchanged 133,138,142 after 1.5 to 12 months of anti-TNF treatment in patients with RA.…”

“…122 Two RCTs in patients with ERA did not show any significant change in both groups with or without anti-TNF treatment 123,125 (details of the anti-TNF reagents used and the control groups are depicted in Table I). However, in another RCT in patients with AS, IMT remained unchanged after 6 months of anti-TNF treatment by GOL, whereas a significant increase in IMT was observed in the placebo group.…”

“Inflammation and arterial stiffness in humans”

“…(Table 2) Three randomized, placebo-controlled trials evaluated the effect of biologic anti-inflammatory agents on arterial stiffness in patients with rheumatoid arthritis (RA). Tam et al [54] and Wong et al [55] both reported significant reduction in PWV after 6 months and about 1 year of treatment, respectively, with anti-TNFa agents in combination with methotrexate but not with methotrexate alone. Kume et al found both tocilizumab (an IL-6 receptor antagonist) and anti-TNF agents to be equally effective in reducing cardiac ankle-vascular index after 24 weeks of therapy [56] while McInnes et al found tocilizumab to not reduce PWV significantly after 12 weeks [57].…”

Epidemiology, risk factors and management of cardiovascular diseases in IBD

“…76 In a randomized controlled trial of 40 patients with active rheumatoid arthritis, patients treated with methotrexate and infliximab had a greater reduction in aortic stiffness than patients treated with methotrexate alone, which was accompanied by a decrease in rheumatoid arthritis disease activity. 77 In light of the lack of data on how anti-TNF agents might modify the risk of cardio vascular disease in patients with IBD, these findings provide i ndirect evidence of a potential beneficial effect.…”