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Randomized Controlled Trial
. 2009 Aug;68(8):1277-84.
doi: 10.1136/ard.2007.086157. Epub 2008 Oct 17.

Infliximab improves vascular stiffness in patients with rheumatoid arthritis

M Wong  1 , S P Oakley, L Young, B Y Jiang, A Wierzbicki, G Panayi, P Chowienczyk, B Kirkham
Affiliations
Randomized Controlled Trial

Infliximab improves vascular stiffness in patients with rheumatoid arthritis

M Wong et al. Ann Rheum Dis. 2009 Aug.

Abstract

Objectives: Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. Tumour necrosis factor alpha (TNFalpha)-blocking therapy has been shown to reduce RA disease activity measures and joint damage progression. Some observational studies suggest that TNFalpha blockade reduces mortality and incidence of first cardiovascular events. The mechanisms contributing to these outcomes are unclear. This study assessed the effects of infliximab treatment on vascular stiffness and structure in patients with RA.

Methods: A post hoc analysis of longitudinal data from a randomised placebo controlled study evaluated the effect of infliximab on vascular assessments. 26 patients received intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter to week 54. Patients were followed up to 56 weeks of infliximab therapy with assessments of RA disease activity, cardiovascular risk factors, vascular stiffness (pulse wave velocity (PWV)), carotid intima media thickness (CIMT) and carotid artery plaque (CAP). Univariate analyses of changes over time by repeated measures analysis of variance (ANOVA) were followed by multivariate time-series regression analysis (TSRA) if changes were seen.

Results: PWV was significantly lower (better) after 56 weeks of treatment with infliximab (ANOVA p<0.01, TSRA p<0.01). However, CIMT (ANOVA p = 0.50) and CAP (chi(2) = 4.13, p = 0.88) did not change over the study period. Multiple cardiovascular risk measures did not change with treatment and did not correlate with changes in measures of vascular structure.

Conclusions: Arterial stiffness improves with infliximab treatment in RA. This change may help explain the improved cardiovascular disease survival in patients with RA receiving TNFalpha-blocking therapy.

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Conflict of interest statement

Competing interests: BK conducts clinical trials and sits on speaker panels for Abbott, Centocor, Schering-Plough, Bristol-Meyers-Squibb and Amgen. SPO conducts trials for Amgen, Abbott, Centocor and Bristol-Myers-Squibb.

Figures

Figure 1
Figure 1
Comparison of disease activity (DAS), heart rate, systolic and diastolic blood pressure in infliximab (IFX) and placebo (Plac) groups during the placebo controlled phase of the trial. ESR, erythrocyte sedimentation rate.
Figure 2
Figure 2
Post hoc analysis: trends in vascular measurements and rheumatoid arthritis disease activity (DAS) during treatment with infliximab (IFX). Repeated measures (RM) ANOVA p values indicate the significance of the overall trend while comparison between paired time points are compared by t tests adjusted for multiple comparisons (Bonferroni correction). ESR, erythrocyte sedimentation rate.
Figure 3
Figure 3
Post hoc analysis: trends in cardiovascular risk factors during treatment with infliximab (IFX). Repeated measures (RM) ANOVA p values indicate the significance of the overall trend while comparisons between paired time points are made by t test adjusted for multiple comparisons (Bonferroni correction). BP, blood pressure; HDL, high-density lipoprotein; HOMA, insulin resistance measured by log homeostasis model assessment; LDL, low-density lipoprotein.
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References

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