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Year : 2007  |  Volume : 2  |  Issue : 1  |  Page : 8-10

Long-term follow up of infliximab therapy in inflammatory arthritis

1 Department of Rheumatology, Army Hospital (R&R), Delhi Cantt, India
2 Department of Medicine, Command Hospital (EC), Kolkata, India

Correspondence Address:
K Narayanan
Department of Rheumatology, Army Hospital (R&R), Delhi Cantt
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Source of Support: None, Conflict of Interest: None

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Objectives: To evaluate the long-term clinical response to infliximab in patients with inflammatory arthritis and to document any undesirable effects on follow-up. Methods: This 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 5 mg/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. Results: There 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 antitu- berculosis 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. Conclusions: Anti-TNF-α (tumour necrosis factor-α) agent infliximab is effective in the management of inflamma- tory 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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