Rescue of combination therapy failures using infliximab, while maintaining the combination or monotherapy with XXXX : results of an open trial.

@entity1 @entity301 @entity5 @entity146 @entity205 @entity1500 @entity1729 @entity1499 @entity309 @entity19833
OBJECTIVE: To assess the possible clinical and biological rescue of @entity309 ( @entity309 ) in 16 @entity1 who were still active despite intensive combination therapy after receiving infliximab following the @entity5 factor Trial in @entity309 with Concomitant Therapy (ATTRACT) schedule. METHODS: Sixteen @entity1 who were still active despite combination therapy with optimal doses of @entity1499 ( @entity1500 15-17.5 mg/week) and @entity205 ( @entity19833 .5-3.5 mg/day) received infliximab. Ten received their combination plus infliximab (Combi), and six received infliximab plus @entity1500 alone (Mono). The follow-up was carried out for 30 weeks in all @entity1 and for 46 weeks in eight. Efficacy and safety were examined. RESULTS: At entry, the mean disease activity score (DAS) was 5.6 (all @entity1 had a DAS >3.7). After therapy, eight of 10 @entity1 in Combi and four out of six in Mono showed an improvement of >50% in the initial swollen joint count, yet only one @entity1 reached 50% improvement in the initial DAS after 30 weeks, and one @entity1 had a DAS <2.4 (low disease activity). Of the eight @entity1 who reached 46 weeks of follow-up, three showed an improvement in DAS of 50% and two had a DAS <2.4. When considering the change over time, the difference between DAS at entry and at week 30 was statistically significant only in @entity1 receiving @entity1500 plus CsA, while it was not significant in those receiving @entity1500 only. Two @entity1 developed recurrent @entity1729 in the Combi therapy group, while two had a single febrile infection in the @entity1500 alone group. Two @entity1 became strongly anti-cardiolipin positive (IgM >40 MPL) and one developed a @entity301 . CONCLUSION: Infliximab can be added incrementally to @entity1500 plus CsA, with favourable results in terms of efficacy and safety over time in severe rapidly @entity146 and progressive @entity309 . Finally, minor evidence emerged for a stronger efficacy of the Combi treatment compared with Mono.
