For people in the beginning stages of rheumatoid arthritis but who have a poor prognosis, early treatment with the drug Remicade can pay dividends, according to the results of a small study.

Remicade, known technically as infliximab, is a biological product that blocks the inflammatory substance TNF-alpha.

Anti-TNF-alpha agents are among the most effective therapies for rheumatoid arthritis, although their optimal use has yet to be determined, Dr. Paul Emery from Leeds General Infirmary in the UK and colleagues note in the medical journal Arthritis and Rheumatism.

Due to their high cost, these biologics are often used only after other less expensive therapies have failed to control arthritis.

However, in the current study, “The use of optimal therapy at the earliest possible stage produced a suppression of disease which was sustained even when the biologic therapy was ceased. This is the first time this has been observed,” Emery told Reuters Health.

His team randomly assigned 20 patients with rheumatoid arthritis who were already being treated with methotrexate to additional treatment with Remicade or an inactive placebo for 12 months.

The participants had had arthritis symptoms for less than 12 months but were expected to deteriorate rapidly. “This was a pilot study which used magnetic resonance imaging to pre-select patients for poor prognosis,” Emery explained.

The investigators found that treatment with Remicade plus methotrexate induced remission. “At 1 year, all MRI scores were significantly better, with no new erosions,” in the infliximab group compared to the placebo group, they report.

The rapid control of arthritis with infliximab “was paralleled by a rapid (less than 14 weeks), sustained (104 weeks), and significant improvement in function and quality of life scores,” according to the researchers.

Emery and colleagues note that the benefits of infliximab were still evident in 70 percent of patients 12 months after the agent was halted.

“The reluctance to recommend (anti-TNF-alpha agents) for first-line use in early rheumatoid arthritis is principally economic, since the cost of life-long treatment of such a prevalent disease would be beyond any realistic budget,” the investigators point out.

“The approach presented may offer the potential for the drug to be used for a limited (affordable) period, at a time when it has the greatest opportunity to make a difference,” they suggest.

SOURCE: Arthritis and Rheumatism, January 2005.