THU0188 Efficacy of infliximab for suppressing radiographic progression of cervical lesions in patients with rheumatoid arthritis comparison with methotrexate; three years of follow-up ~a multicenter registry study ~
Authors: Y. Kanayama, T. Kojima, Y. Hirano, N. Takahashi, N. Ishiguro
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with biological agents are more clinically effective than the DMARDs that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasised. We reported the efficacy of infliximab (IFX), anti-tumour necrosis factor antibodies for suppressing the radiographic progression of RA cervical lesions at ACR2009, EULAR2010, 11, 12, 13, 14 and 16. However there is still few studies of efficacy of against RA cervical lesions of IFX comparison with methotrexate(MTX). <h3>Objectives</h3> To evaluate the efficacy of IFX for suppressing the radiographic progression of RA cervical lesions comparison with MTX for 3 years. <h3>Methods</h3> We used MTX or MTX +IFX for treating Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of each 64 and 70 patients received continuous MTX and IFX treatment for at least 3 years. MTX was used in all patients receiving IFX. For evaluation of cervical lesions, the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at initiation, Year 1, 2 and 3. <h3>Results</h3> In the patients receiving MTX (n=64) and IFX (n=70), the number of female were each 46 (72%) and 60 (86%) cases(p=0.049). The mean age was 63.4±11.0 and 54.2±12.8 years old (p&lt;0.001); disease duration was 8.5±9.8 and 10.5±9.3 years (p=0.027) and the mean dose of MTX was 7.9±2.8 and 7.5±1.7 mg/w (p=0.607). Clinical findings related to RA were as follows; CRP 1.5±2.1 and 3.3±3.0 mg/dl(p&lt;0.001); ESR 29.9±21.1 and 54.9±23.9 mm/h(p&lt;0.001); MMP3 223±373 and 355±328 ng/ml(p&lt;0.001); DAS28 4.21±1.35 and 5.43±1.29 (p&lt;0.001); ADI 2.7±1.6 and 3.4±1.7 mm(p=0.005); SAC 20.7±2.6 and 18.4±2.5 mm(p&lt;0.001) and Ranawat value 15.9±1.5 and 14.5±2.3 mm (p&lt;0.001). The respective changes in cervical lesion parameters after 3 years were as follows: ADI: 0.70±0.77 and 0.47±0.74 mm (p=0.042); SAC: −0.69±0.85 and −0.44±0.79 mm (p=0.043); and Ranawat value: −0.48±0.69 and −0.34±0.51 mm (p=0.359) between MTX and IFX patients (figure 1). The numbers of patients who did not showed progression in ADI, SAC and Ranawat value were each 30 (47%) vs 45 (64%) cases(p=0.043); 33 (52%) vs 48 (69%) cases(p=0.044) and 40 (63%) vs 47 (67%) cases(p=0.574) after 3 years. Also the number who was able to suppress progression in all three parameters were each 30 cases (47%) receiving MTX and 39 cases (56%) receiving IFX (p=0.307) after 3 years (figure 2). <h3>Conclusions</h3> This study suggested that IFX treatment can be used to suppress the progression of RA cervical lesions more than MTX treatment. <h3>Disclosure of Interest</h3> Y. Kanayama: None declared, T. Kojima Speakers bureau: Mitsubishi Tanabe Pharma, Takeda Pharma, Eisai Pharma, AbbVie, Bristol-Myers Squibb, and Pfizer, Janssenn Pharmaceutical Companies, Astellas Pharma and Chugai Pharma., Y. Hirano Speakers bureau: Abbvie Japan, Eisai, Mitsubishi Tanabe Pharma, Pfizer, Chugai Pharmaceutical, and Bristol-Myers Squibb., N. Takahashi Speakers bureau: Abbvie Japan Co. Ltd, Eisai Co. Ltd, UCB Japan Co. Ltd, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Ltd, Pfizer Co. Ltd, Chugai Pharmaceutical Co. Ltd, Janssen Pharmaceutical K.K., and Bristol-Myers Squibb Co. Ltd., N. Ishiguro Grant/research support from: Daiichi Sankyo, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Taisho Toyama Pharmaceutical, Kaken Pharmaceutical, Eisai, Janssen Pharmaceutical, Bristol-Myers Squibb, AbbVie, Chugai Pharmaceutical, Mitsubishi Tanabe Pharmaceutical, Astellas Pharma, and Pfizer Japan, Speakers bureau: Daiichi Sankyo, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Taisho Toyama Pharmaceutical, Kaken Pharmaceutical, Eisai, Janssen Pharmaceutical, Bristol-Myers Squibb, AbbVie, Chugai Pharmaceutical, Mitsubishi Tanabe Pharmaceutical, Astellas Pharma, and Pfizer Japan.