インフリキシマブ投与関節リウマチ患者の臨床的検討 ―長期的な有効性と安全性について―

抄録

    We started therapy with infliximab (IFX) at our hospital in 36 rheumatoid arthritis (RA) patients with an inadequate response to low dose methotrexate (MTX). In 21 patients, the therapy duration has currently reached 22 weeks or longer, the longest being 134 weeks. During the therapy, RA activity was evaluated using markers such as CRP, MMP-3, RF and ESR. After the start of IFX, all the markers showed a decrease, which persisted for 134 weeks, and the therapy was continued in approximately 80% of the patients. Four patients dropped out; the reasons were spondylodesis for atlantoaxial subluxation in one patient and switching to etanercept (ETN) due to attenuation of IFX effects in two patients. The fourth patient was considered as a complete responder with a marked improvement in CRP after the start of IFX. The patient achieved a remission-like status approximately 1 year after the start of the therapy, which has still been maintained despite the subsequent discontinuation. On the other hand, three patients required an increase in steroid doses during the IFX therapy, and four patients were treated at decreased doses. Although some clinicians have pointed out attenuation of IFX effects after 22 weeks, the above findings revealed its infrequency. This clinical evaluation demonstrated that IFX may be sustainably effective and relatively safe, having long-lasting, excellent effects in RA patients (especially early RA), which existing DMARDs do not have. As a new treatment for RA, IFX is considered an indispensable drug as a new treatment for RA. However, adequate monitoring of adverse reactions is necessary.