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Infliximab (Remicade) in the treatment of psoriatic arthritis.

Mease P - Ther Clin Risk Manag (2006)

Bottom Line: Elucidation of the cellular immunopathology and cytokine profile of psoriatic arthritis (PsA), a chronic inflammatory disease associated with psoriasis, has resulted in the development of a number of novel biologic therapies.The pivotal role of TNF-alpha in the pathogenesis and progression of PsA suggested that anti-TNF-alpha agents could be effective in controlling PsA.The development of other anti-TNF-alpha biologics is also discussed.

View Article: PubMed Central - PubMed

Affiliation: Seattle Rheumatology Associates, Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine Seattle, WA, USA.

ABSTRACT
Elucidation of the cellular immunopathology and cytokine profile of psoriatic arthritis (PsA), a chronic inflammatory disease associated with psoriasis, has resulted in the development of a number of novel biologic therapies. Among these biologics, tumor necrosis factor-alpha (TNF-alpha) inhibitors have been used successfully to treat patients suffering from rheumatoid arthritis or psoriasis. The pivotal role of TNF-alpha in the pathogenesis and progression of PsA suggested that anti-TNF-alpha agents could be effective in controlling PsA. The results from two large, randomized, double-blind, placebo-controlled trials in patients with moderate to severe PsA indicated that the anti-TNF-inhibitor, infliximab, can control both the joint and skin manifestations of the disease. This review focuses on the clinical development of infliximab as a treatment for PsA. The development of other anti-TNF-alpha biologics is also discussed.

No MeSH data available.


Related in: MedlinePlus

Percentages of patients achieving improvement by the American College of Rheumatology 20% (ACR20) criteria for improvement in rheumatoid arthritis through week 50. Results from the Phase III, IMPACT trial that assessed the effectiveness of infliximab for treating psoriatic arthritis. Copyright © 2005. Reproduced with permission from Antoni CE, Kavanaugh A, Kirkham B, et al. 2005. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum, 52:1227–36. Arrows indicate weeks at which infusions were administered: open arrows denote placebo (Pbo) infusions, and solid arrows denote infusions of infliximab (Inf) 5 mg/kg.
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fig2: Percentages of patients achieving improvement by the American College of Rheumatology 20% (ACR20) criteria for improvement in rheumatoid arthritis through week 50. Results from the Phase III, IMPACT trial that assessed the effectiveness of infliximab for treating psoriatic arthritis. Copyright © 2005. Reproduced with permission from Antoni CE, Kavanaugh A, Kirkham B, et al. 2005. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum, 52:1227–36. Arrows indicate weeks at which infusions were administered: open arrows denote placebo (Pbo) infusions, and solid arrows denote infusions of infliximab (Inf) 5 mg/kg.

Mentions: The proportion of infliximab-treated patients who achieved ACR20 at 16 weeks was 65%, which was significantly higher (p<0.001) than the response of the placebo group (10%) (Antoni, Kavanaugh, et al 2005). Moreover, 46% of infliximab-treated patients achieved an ACR50 and 29% achieved an ACR70 response, whereas none of the placebo-treated patients achieved either of these two endpoints (p<0.001). At the 16-week evaluation, 75% of infliximab-treated patients improved according to PsARC, compared with only 21% of placebo-treated patients (p<0.001). The percentage improvement in ACR20 achieved by infliximab-treated patients at week 16 was sustained through week 50 of the study (Figure 2). Moreover, crossover patients from the placebo group, who received infliximab therapy after week 16, achieved ACR20 response rates at week 50 that were comparable with those exhibited by patients who were initially placed in the infliximab treatment group. It is important to note that, at week 16, the concomitant use of DMARDs (primarily MTX) had no significant effect on the ACR20 response rate in either the infliximab-treated or placebo groups. For example, 62.5% of infliximab patients also receiving MTX achieved an ACR20 response rate at 16 weeks, as did 68% of infliximab patients not receiving MTX and 74% of patients not receiving DMARD therapy.


Infliximab (Remicade) in the treatment of psoriatic arthritis.

Mease P - Ther Clin Risk Manag (2006)

Percentages of patients achieving improvement by the American College of Rheumatology 20% (ACR20) criteria for improvement in rheumatoid arthritis through week 50. Results from the Phase III, IMPACT trial that assessed the effectiveness of infliximab for treating psoriatic arthritis. Copyright © 2005. Reproduced with permission from Antoni CE, Kavanaugh A, Kirkham B, et al. 2005. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum, 52:1227–36. Arrows indicate weeks at which infusions were administered: open arrows denote placebo (Pbo) infusions, and solid arrows denote infusions of infliximab (Inf) 5 mg/kg.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC1936360&req=5

fig2: Percentages of patients achieving improvement by the American College of Rheumatology 20% (ACR20) criteria for improvement in rheumatoid arthritis through week 50. Results from the Phase III, IMPACT trial that assessed the effectiveness of infliximab for treating psoriatic arthritis. Copyright © 2005. Reproduced with permission from Antoni CE, Kavanaugh A, Kirkham B, et al. 2005. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum, 52:1227–36. Arrows indicate weeks at which infusions were administered: open arrows denote placebo (Pbo) infusions, and solid arrows denote infusions of infliximab (Inf) 5 mg/kg.
Mentions: The proportion of infliximab-treated patients who achieved ACR20 at 16 weeks was 65%, which was significantly higher (p<0.001) than the response of the placebo group (10%) (Antoni, Kavanaugh, et al 2005). Moreover, 46% of infliximab-treated patients achieved an ACR50 and 29% achieved an ACR70 response, whereas none of the placebo-treated patients achieved either of these two endpoints (p<0.001). At the 16-week evaluation, 75% of infliximab-treated patients improved according to PsARC, compared with only 21% of placebo-treated patients (p<0.001). The percentage improvement in ACR20 achieved by infliximab-treated patients at week 16 was sustained through week 50 of the study (Figure 2). Moreover, crossover patients from the placebo group, who received infliximab therapy after week 16, achieved ACR20 response rates at week 50 that were comparable with those exhibited by patients who were initially placed in the infliximab treatment group. It is important to note that, at week 16, the concomitant use of DMARDs (primarily MTX) had no significant effect on the ACR20 response rate in either the infliximab-treated or placebo groups. For example, 62.5% of infliximab patients also receiving MTX achieved an ACR20 response rate at 16 weeks, as did 68% of infliximab patients not receiving MTX and 74% of patients not receiving DMARD therapy.

Bottom Line: Elucidation of the cellular immunopathology and cytokine profile of psoriatic arthritis (PsA), a chronic inflammatory disease associated with psoriasis, has resulted in the development of a number of novel biologic therapies.The pivotal role of TNF-alpha in the pathogenesis and progression of PsA suggested that anti-TNF-alpha agents could be effective in controlling PsA.The development of other anti-TNF-alpha biologics is also discussed.

View Article: PubMed Central - PubMed

Affiliation: Seattle Rheumatology Associates, Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine Seattle, WA, USA.

ABSTRACT
Elucidation of the cellular immunopathology and cytokine profile of psoriatic arthritis (PsA), a chronic inflammatory disease associated with psoriasis, has resulted in the development of a number of novel biologic therapies. Among these biologics, tumor necrosis factor-alpha (TNF-alpha) inhibitors have been used successfully to treat patients suffering from rheumatoid arthritis or psoriasis. The pivotal role of TNF-alpha in the pathogenesis and progression of PsA suggested that anti-TNF-alpha agents could be effective in controlling PsA. The results from two large, randomized, double-blind, placebo-controlled trials in patients with moderate to severe PsA indicated that the anti-TNF-inhibitor, infliximab, can control both the joint and skin manifestations of the disease. This review focuses on the clinical development of infliximab as a treatment for PsA. The development of other anti-TNF-alpha biologics is also discussed.

No MeSH data available.


Related in: MedlinePlus