Open‐label study of infliximab treatment for psoriatic arthritis: Clinical and magnetic resonance imaging measurements of reduction of inflammation

Antoni, Christian; Dechant, Claudia; Lorenz, Patrick; Wendler, J.; Ogilvie, Adaling; Lueftl, Mathias; Kalden-Nemeth, Dolores; Kalden, Joachim R.; Manger, Bernhard

doi:10.1002/art.10671

Cited by 149 publications

(85 citation statements)

References 30 publications

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“…Then, US appears to be a valuable tool for the assessment of the response to treatment in RA, and it has many advantages over other diagnostic methods and clinical indices of disease activity such as the low cost, noninvasiveness and possibility of a contemporaneous assessment of inflammatory and structural changes. The close relationship between our US findings and the standardly used clinical and serological indices of disease activity strengthen further the case for using US as one of the investigations of choice in the monitoring of biologic therapy in RA [36][37][38][39][40][41][42][43][44][45][46].…”

Section: Discussionsupporting

confidence: 57%

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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We evaluated clinically and sonographically the effects of etanercept therapy in patients with rheumatoid arthritis (RA) over 12 months of treatment. Eighteen patients affected by RAwho were non-responders or partial responders to disease modifying therapy were commenced on Etanercept treatment. Before starting therapy (T0) and at 12 months (T1), the following parameters were evaluated: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) for pain, number of painful and swollen joints, health assessment questionnaire (HAQ) and disease activity score in 28 joints (DAS 28). Musculoskeletal ultrasound (US) was performed in the following joints: second and fifth metacarpophalangeal, third interphalangeal, wrist and knee joints and a semiquantitative score (0-3) calculated and used to indicate the presence of a localised inflammatory process (synovitis, tenosynovitis, bursitis) and/or structural damage (bone erosion and cartilaginous change). An overall score was calculated based on the sum of the single scores to obtain a comprehensive score indicative of the global pathological change. The US global scores significantly reduced between T0 and T1 (p<0.0001). The following laboratory and clinical parameters also significantly reduced: ESR (p<0.0001), CRP (p<0.02), VAS (p<0.001), number of total swollen joints (p<0.001), number of total painful joints (p<0.01), HAQ scores (p<0.05) and DAS 28 (p< 0.0001). A positive response to treatment with Etanercept was demonstrated both by US examination of several joints and by clinical evaluation of several parameters. US is a useful tool in the monitoring of biologic therapy in RA, assessing both inflammatory and destructive changes.

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Section: Discussionsupporting

confidence: 57%

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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“…In addition, discontinuation rates due to lack of response and adverse events are typically high for conventional systemic therapies (38), and longterm safety is a concern (39,40). Two biologic agents, etanercept and infliximab, have recently been shown to be effective in the treatment of PsA, and these agents along with alefacept also reduce psoriasis symptoms (17)(18)(19). These therapies require injections or infusions, and cost may be a barrier to their use.…”

Section: Discussionmentioning

confidence: 99%

“…These agents, as well as other treatment options such as low-dose oral MTX (Յ15 mg/week), cyclosporine, and intramuscular gold, often fail to improve joint and skin symptoms or are poorly tolerated (14)(15)(16). Recently, a tumor necrosis factor (TNF) inhibitor, etanercept, has demonstrated significant efficacy in the treatment of PsA and psoriasis (17), and preliminary data suggest the same for the TNF inhibitor infliximab (18). Another biologic agent, alefacept, a lymphocyte function-associated antigen 3 fusion protein that blocks T cell activation, is available for the treatment of psoriasis and may also be useful in PsA (19).…”

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confidence: 99%

Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: A multinational, double‐blind, randomized, placebo‐controlled clinical trial

Kaltwasser

Nash

Gladman

et al. 2004

Arthritis & Rheumatism

377

194

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Objective. Current treatment options for psoriatic arthritis (PsA) are limited. Leflunomide, an oral pyrimidine synthesis inhibitor, is highly effective in the treatment of rheumatoid arthritis, and small studies have suggested similar efficacy in PsA. We undertook this double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of leflunomide in patients with PsA and psoriasis.Methods. One hundred ninety patients with active PsA and psoriasis (at least 3% skin involvement) were randomized to receive leflunomide (100 mg/day loading dose for 3 days followed by 20 mg/day orally) or placebo for 24 weeks. The primary efficacy end point was the proportion of patients classified as responders by the Psoriatic Arthritis Response Criteria (PsARC). Additional efficacy (joint and skin involvement), safety, and quality-of-life assessments were performed.Results Conclusion. Leflunomide is an effective treatment for PsA and psoriasis, providing a safe and convenient alternative to current therapies.

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“…Infliximab (cA2, Remicade; Centocor, Malvern, PA) is a chimeric monoclonal antibody of IgG1 isotype with specificity and high affinity (K a 10 10 /mole) for TNF␣. Infliximab has been used successfully in AS (13)(14)(15) and other spondylarthritides, such as psoriatic arthritis (16), following its approval for use in rheumatoid arthritis (RA) (17). Although infliximab has been shown to stop radiographic progression of RA (18), this effect has not yet been studied in AS.…”

mentioning

confidence: 99%

Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: Evaluation of a new scoring system

Braun

Baraliakos

Golder

et al. 2003

Arthritis & Rheumatism

370

225

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Objective. To evaluate a magnetic resonance imaging (MRI) scoring system for the assessment of spinal inflammation in patients with ankylosing spondylitis (AS) who participated in a randomized, placebocontrolled trial of infliximab, and to examine whether infliximab is also effective for the reduction of MRIproven spinal inflammation.Methods. Twenty patients with AS (9 women and 11 men, mean age 40.9 years) were examined at baseline and after 3 months. Nine patients had received infusions of infliximab (5 mg/kg body weight) at weeks 0, 2, and 6, and 11 patients had received placebo. Three MRI sequences and 2 scoring systems were used. Chronic lesions were evaluated by T1-weighted turbo spin-echo (TSE) sequences and were assigned a chronicity score. Active lesions were evaluated either by repetition of T1-weighted TSE sequences after infusion of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) or by short tau inversion recovery (STIR) sequences, and were assigned an activity score. The 40 images were evaluated twice by 2 readers who were blinded to the names of the patients and the dates of the examinations, and were analyzed in relation to the clinical results.Results. Active spinal lesions were detected in 15 of 20 patients (75%); the frequency as determined by STIR was equal in the 2 groups. At baseline, the total MRI scores determined using Gd-DTPA, STIR, and T1 were 112.5, 156, and 253.5, respectively. The interrater variance and intrarater variance were, respectively, 6.4 and 7.7 for the active lesion score as determined by Gd-DTPA, 15.7 and 5.3 for the active lesion score as determined by STIR sequence, and 167.3 and 75.5 for the chronic lesion score as determined by T1 sequence. Based on the means of the scores assigned by the 2 readers, the active lesion score as determined by Gd-DTPA improved by 40% in the infliximab group compared with 6% in the placebo group, the active lesion score as determined by STIR improved by 60% in the infliximab group but deteriorated by 21% in the placebo group, and the chronic lesion score as determined by T1 improved by 7% in the infliximab group but worsened by 35% in the placebo group. Five patients in the infliximab group and 2 in the placebo group were clinical responders. The acute MRI changes correlated with clinical improvement as assessed by the Bath Ankylosing Spondylitis Disease Activity Index.Conclusion. This novel MRI scoring system performed well in assessing acute inflammation by using STIR and post-Gd-DTPA sequences. In correlation with clinical improvement in patients with active AS who were treated with infliximab, significant regression of 1 J. Braun, MD: Rheumazentrum Ruhrgebiet,

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Open‐label study of infliximab treatment for psoriatic arthritis: Clinical and magnetic resonance imaging measurements of reduction of inflammation

Abstract: Objective. To evaluate infliximab efficacy and safety in disease-modifying antirheumatic drug-unresponsive psoriatic arthritis (PsA).

Cited by 149 publications

References 30 publications

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: A multinational, double‐blind, randomized, placebo‐controlled clinical trial

Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: Evaluation of a new scoring system

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