Long-term infliximab treatment in rheumatoid arthritis: subsequent outcome of initial responders

Abstract

This study of patients treated in clinical practice with infliximab demonstrated that secondary non-response occurred in around half the patients in the first year. The data highlight the need to continue development of other therapies as well as investigation of the underlying causes of this loss of response.

Infliximab treatment in patients with rheumatoid arthritis and spondyloarthropathies in one rheumatological center: two years’ drug survival

“…In observational studies, continuation rates are usually lower than in clinical randomized trials, 66% of the patients continued infliximab infusions after one year [8] and after two years' intervention 67% [9] and 73% [10] drug survival rates were reported. In the study of Buch et al, only 27 out of 174 patients (16%) continued infliximab treatment at the 24 months' time-point [14]. In the present study, 40% of the patients continued with infliximab treatment after the two years' follow-up 13 since they had achieved at least a 50% response without any severe adverse event or other reason requiring discontinuation of the treatment.…”

“…According to the patients' records, 6 / 23 patients discontinued the treatment due to inadequate response during the first seven months, and 17 / 23 patients had an appropriate response at the beginning but discontinued the treatment later because of waning efficacy. Buch et al reported also that some patients could not maintain an already achieved response at later time points [14]. In observational studies, the rate of discontinuation due to inefficacy varies between 9.2-11% [8, 10,16].…”

“…In previous reports, hypersensitivity reactions have been a notable reason for discontinuation of infliximab treatment, and they have most frequently occurred during the second to fourth infusion [14,15] manifesting as urticaria, rash, itching and dyspnoea. In the clinical study of Maini et al [1], hypersensitivity reactions appeared most commonly during the first infusion.…”

“…It is routinely used in the everyday practice when traditional DMARDs are not sufficiently effective. Although infliximab is generally safe and well tolerated, sometimes the treatment must be discontinued due to adverse events [1][2][3][6][7][8][9][10], mainly infections [11][12][13][14] and hypersensitivity reactions [14,15]. In addition, inadequate or waning efficacy complicates drug survival in infliximab-treated patients [8, 10,14,16].…”

Animal models of rheumatoid arthritis: How informative are they?

“…However, despite the undoubted success of anti-TNFα, only a quarter of patients treated with a combination of a TNFα inhibitor plus methotrexate achieve disease remission (defined as a DAS-28 score of less than 2.6). In addition, up to 50% of primary responders lose their response within 12 months of the start of therapy (Buch et al, 2007). Hence, there remains a need for more effective anti-arthritic medicines.…”