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Improvement in insulin resistance is greater when infliximab is added to methotrexate during intensive treatment of early rheumatoid arthritis--results from the IDEA study.
- Source :
-
Rheumatology . Dec2016, Vol. 55 Issue 12, p2181-2190. 10p. 1 Diagram, 5 Charts. - Publication Year :
- 2016
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Abstract
- Objectives. To determine the change in established biomarkers of cardiovascular (CV) risk, namely, total cholesterol/high-density lipoprotein cholesterol ratio (TC/HDL-C), N-terminal pro-brain natriuretic peptide (NT-proBNP) and insulin resistance (IR) in patients with early RA treated with two different treat-to-target strategies. Methods. Fasting glucose, lipids, insulin and NT-proBNP were measured at baseline, weeks 26 and 78 in 79 DMARD-naTve RA patients, free of CV disease, as part of a double-blind randomized controlled trial of MTX with either infliximab (IFX) or methylprednisolone as induction therapy. Homeostasis model assessment-estimated IR (HOMA-IR) (glucose*insulin/405) was used to measure IR. Multiple imputation was employed, and linear regression analyses were adjusted for baseline values. Results. Changes in DAS44-CRP did not differ between the treatment arms at weeks 26 and 78. Mean TC/ HDL-C, HOMA-IR and NT-proBNP improved in both groups at weeks 26 and 78, although change in NT-proBNP was not statistically significant at week 78. Changes in TC/HDL-C and NT-proBNP were similar between treatment arms, but HOMA-IR values in the IFX + MTX arm were 42% lower than those treated with MTX + methylprednisolone at week 78 (P = 0.003); the difference remained significant after adjustment for baseline BMI, ACPA positivity, smoking status and intramuscular glucocorticoid use (P = 0.007). Conclusion. When implementing a treat-to-target approach, treatment of early RA was associated with improvement in TC/HDL-C, HOMA-IR and NT-proBNP, and a greater long-term improvement in HOMA-IR was seen in those treated with IFX. Trial registration: EU Clinical Trials Register, http://www.clinicaltrialsregister.eu, Eudract-2005-005013-37; ISRTCNregisrty, http://www.isrctn.com, ISRCTN48638981 [ABSTRACT FROM AUTHOR]
- Subjects :
- *METHOTREXATE
*INFLIXIMAB
*BIOMARKERS
*CARDIOVASCULAR diseases risk factors
*COMBINATION drug therapy
*CLINICAL trials
*HIGH density lipoproteins
*INSULIN resistance
*PEPTIDE hormones
*QUESTIONNAIRES
*RESEARCH funding
*RHEUMATOID arthritis
*STATISTICS
*DATA analysis
*MULTIPLE regression analysis
*TREATMENT effectiveness
*SEVERITY of illness index
*DATA analysis software
*DESCRIPTIVE statistics
Subjects
Details
- Language :
- English
- ISSN :
- 14620324
- Volume :
- 55
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 120340028
- Full Text :
- https://doi.org/10.1093/rheumatology/kew306