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AMSTERDAM — Early and aggressive therapy with infliximab and methotrexate may favorably alter the course of rheumatoid arthritis, according to new data from the Dutch BEST trial.
After 3 years of follow-up, 55% of the 120 BEST participants initially randomized to combined therapy with infliximab and methotrexate were able to wean off infliximab. They had discontinued infliximab a median of 26 weeks earlier, thereafter consistently maintaining a Disease Activity Score (DAS) of 2.4 or less, down from a mean baseline DAS of 4.3, Dr. Arie E. van der Bijl reported at the annual European Congress of Rheumatology.
After discontinuing infliximab, most of these patients remained on methotrexate maintenance monotherapy. Of particular note was the finding that 17 patients, or 14% of the original 120, were in clinical remission as defined by a DAS of 1.6 or less without any antirheumatic drugs.
BEST is a multicenter randomized trial comparing four different treatment strategies in 506 patients with early rheumatoid arthritis (RA). Although several audience members speculated that similarly favorable 3-year results might have been achieved with early methotrexate monotherapy, which is known to produce very good outcomes in a minority of RA patients, Dr. van der Bijl of Leiden University Medical Center, the Netherlands, was quick to correct them. Another of the four BEST study arms featured exactly that strategy, and the results in terms of rates of low disease activity or clinical remission weren't nearly as good as in the combined infliximab/methotrexate arm.
The new BEST results warrant cautious interpretation. Whether early infliximab plus methotrexate alters the course of RA must await longer-term follow-up, including radiologic evidence of prevention of progressive joint damage, he stressed.
BEST is supported by the Dutch government and the Dutch College of Health Insurance Companies.
AMSTERDAM — Early and aggressive therapy with infliximab and methotrexate may favorably alter the course of rheumatoid arthritis, according to new data from the Dutch BEST trial.
After 3 years of follow-up, 55% of the 120 BEST participants initially randomized to combined therapy with infliximab and methotrexate were able to wean off infliximab. They had discontinued infliximab a median of 26 weeks earlier, thereafter consistently maintaining a Disease Activity Score (DAS) of 2.4 or less, down from a mean baseline DAS of 4.3, Dr. Arie E. van der Bijl reported at the annual European Congress of Rheumatology.
After discontinuing infliximab, most of these patients remained on methotrexate maintenance monotherapy. Of particular note was the finding that 17 patients, or 14% of the original 120, were in clinical remission as defined by a DAS of 1.6 or less without any antirheumatic drugs.
BEST is a multicenter randomized trial comparing four different treatment strategies in 506 patients with early rheumatoid arthritis (RA). Although several audience members speculated that similarly favorable 3-year results might have been achieved with early methotrexate monotherapy, which is known to produce very good outcomes in a minority of RA patients, Dr. van der Bijl of Leiden University Medical Center, the Netherlands, was quick to correct them. Another of the four BEST study arms featured exactly that strategy, and the results in terms of rates of low disease activity or clinical remission weren't nearly as good as in the combined infliximab/methotrexate arm.
The new BEST results warrant cautious interpretation. Whether early infliximab plus methotrexate alters the course of RA must await longer-term follow-up, including radiologic evidence of prevention of progressive joint damage, he stressed.
BEST is supported by the Dutch government and the Dutch College of Health Insurance Companies.
AMSTERDAM — Early and aggressive therapy with infliximab and methotrexate may favorably alter the course of rheumatoid arthritis, according to new data from the Dutch BEST trial.
After 3 years of follow-up, 55% of the 120 BEST participants initially randomized to combined therapy with infliximab and methotrexate were able to wean off infliximab. They had discontinued infliximab a median of 26 weeks earlier, thereafter consistently maintaining a Disease Activity Score (DAS) of 2.4 or less, down from a mean baseline DAS of 4.3, Dr. Arie E. van der Bijl reported at the annual European Congress of Rheumatology.
After discontinuing infliximab, most of these patients remained on methotrexate maintenance monotherapy. Of particular note was the finding that 17 patients, or 14% of the original 120, were in clinical remission as defined by a DAS of 1.6 or less without any antirheumatic drugs.
BEST is a multicenter randomized trial comparing four different treatment strategies in 506 patients with early rheumatoid arthritis (RA). Although several audience members speculated that similarly favorable 3-year results might have been achieved with early methotrexate monotherapy, which is known to produce very good outcomes in a minority of RA patients, Dr. van der Bijl of Leiden University Medical Center, the Netherlands, was quick to correct them. Another of the four BEST study arms featured exactly that strategy, and the results in terms of rates of low disease activity or clinical remission weren't nearly as good as in the combined infliximab/methotrexate arm.
The new BEST results warrant cautious interpretation. Whether early infliximab plus methotrexate alters the course of RA must await longer-term follow-up, including radiologic evidence of prevention of progressive joint damage, he stressed.
BEST is supported by the Dutch government and the Dutch College of Health Insurance Companies.