Long-term follow up of infliximab therapy in inflammatory arthritis |
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| Institution: | 1. Department of Rheumatology, Army Hospital (R&R), Delhi Cantt., India;2. Department of Medicine, Command Hospital (EC), Kolkata, India;1. Crystal Growth Centre, Anna University, Chennai 600025, India;2. National Centre for Catalysis Research, Department of Chemistry, IIT Madras, Chennai 25, India;3. National Centre for Nanoscience and Nanotechnology, University of Madras, Guindy Campus, Chennai 600025, India;4. Univ. Bordeaux, ISM UMR CNRS 5255, Bordeaux INP, ENSCBP, 16 avenue Pey Berland, 33607 Pessac, France;1. Materials Division, School of Advanced Sciences, Vellore Institute of Technology (VIT) University, Chennai Campus, Chennai 600 127, Tamil Nadu, India;2. Department of Physics and Abraham Panampara Research Centre, Sacred Heart College (Autonomous), Tirupattur 635 601, Tamil Nadu, India;3. Catalysis and Nanomaterials Research Laboratory, Department of Chemistry, Loyola College (Autonomous), Chennai 600 034,Tamil Nadu, India;1. Guangdong Provincial Key Laboratory of Nanophotonic Functional Materials and Devices, Guangdong Engineering Technology Research Center of Optoelectronic Functional Materials and Devices, Institute of Optoelectronic Materials and Technology, South China Normal University, Guangzhou 510631, China;2. Research Resources Center of South China Normal University, South China Normal University, Guangzhou 510631, China;3. Electron Science Research Institute, Edith Cowan University, West Australia 6027, Australia;1. Division of Energy and Environment, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China;2. School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China |
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| Abstract: | ObjectivesTo evaluate the long-term clinical response to infliximab in patients with inflammatory arthritis and to document any undesirable effects on follow-up.MethodsThis study was conducted in Command Hospital (Eastern Command) between June 2002 and May 2006. Cases of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA) who received infliximab after screening for tuberculosis and concurrent infections were followed up for a minimum period of 2 years after therapy. Infliximab was administered at a dose of 3 mg/kg for RA and JIA, and 5mg/kg for spondyloarthropathy (SpA) at 0, 2 and 6 weeks. Few patients received additional 8 weekly doses. Twelve patients with AS received only 3 mg/kg dose at 8–12 week intervals due to shortage of drug. Disease modifying antirheumatic drugs were continued in all. Monthly follow-up was done to assess the disease activity and document any adverse effects.ResultsThere were 52 patients in total (32 males, 20 females). Of these, 18 had RA, 27 had AS, 4 had JIA and 1 had PsA. All except two showed subjective improvement lasting 6 weeks to 7 months. Adverse effects during infusion and in the immediate post-infusion period were few and not clinically significant. One patient had hypersensitivity reaction following the second dose. However, seven cases of tuberculosis (14%) occurred in the follow-up period from 6 weeks to 1 year after the commencement of infliximab therapy. All patients responded to 6 months of antituberculosis treatment. Two years after the last dose of infliximab, all patients had active arthritis and four patients had to undergo total hip replacement during that period.ConclusionsAnti-TNF-α (tumour necrosis factor-α) agent infliximab is effective in the management of inflammatory arthritis but the improvement can be sustained only by continuing its administration at intervals of 8–20 weeks. In our country, its long-term use may be limited by the high incidence of tuberculosis as shown in our study (14%). Close monitoring for tuberculosis is essential. |
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