The effect of infliximab plus methotrexate on the modulation of inflammatory disease markers in juvenile idiopathic arthritis: Analyses from a randomized,placebo-controlled trial

Background: we evaluated the effect of infliximab on markers of inflammation in patients with juvenile idiopathic arthritis (jia).methods: in this randomized,placebo-controlled substudy,122 patients with jia received infliximab 3 mg/kg + methotrexate (mtx)(n = 60) or placebo + mtx (n = 62) at weeks 0,2,and 6. at week 14,patients receiving placebo + mtx crossed over to infliximab 6 mg/kg + mtx; patients receiving infliximab 3 mg/kg + mtx continued treatment through week 44. sera and plasma from eligible patients receiving infliximab 3 mg/kg + mtx (n = 34) and receiving placebo→infliximab 6 mg/kg +mtx (n = 38) were collected at weeks 0,2,14,16,28,and 52 and analyzed for inflammatory markers (il-6,il-12p40,icam-1,mmp-3,vegf,tnf-α,and crp).results: at week 2,decreases from baseline in il-6,icam-1,mmp-3,tnf-α,and crp were greater with infliximab versus placebo treatment,and with the exception of crp,these differences were generally maintained through week 14. the decreases from baseline to week 52 in il-6,icam-1,vegf,mmp-3,and crp and increases in il-12p40 levels were larger in patients receiving placebo→infliximab 6 mg/kg +mtx versus infliximab 3 mg/kg + mtx treatment. patients receiving infliximab 3 mg/kg+mtx who achieved an american college of rheumatology pediatric 30 (acr-pedi-30) response had significantly larger decreases from baseline in icam-1 (p = 0.0105) and mmp-3 (p = 0.0253) at week 2 and in icam-1 (p = 0.0304),mmp-3 (p = 0.0091),and crp (p = 0.0011) at week 14 versus acr-pedi-30 nonresponders.conclusion: infliximab + mtx attenuated several inflammatory markers in patients with jia; larger decreases in icam-1,mmp-3,and crp levels were observed in acr-pedi-30 responders versus nonresponders. © 2010 visvanathan et al; licensee biomed central ltd.