Ten years of infliximab: Insights from clinical trials in rheumatoid arthritis

Early animal and open label human studies suggested a pivotal role for tumor necrosis factor (TNF) inhibition in the treatment of rheumatoid arthritis (RA). Subsequent randomized controlled trials with infliximab showed a rapid reduction of signs and symptoms as well as fast normalization of C reactive protein (CRP) in patients responding to treatment. In addition, a synergistic effect of methotrexate (MTX) in combination with infliximab was evident. Infliximab treatment can inhibit progression of structural joint damage, a newly reported outcome of TNF inhibition in rheumatoid arthritis shown to be largely independent of clinical response to infliximab treatment. Early treatment with infliximab in combination with methotrexate in methotrexate-naive patients showed similar inhibition of x-ray progression, and change of the natural course of disease thus became an achievable treatment goal in rheumatoid arthritis. Current clinical practice in rheumatology aims at obtaining low disease activity and remission state. Application of new treatment strategies with tight control of disease activity allows to reach these new treatment goals in many patients. The extended research programs of infliximab have added significant knowledge to our current clinical management of rheumatoid arthritis patients. We also learned, however, that anti-TNF treatment is not without risk, and that careful patient selection, screening, and monitoring are vital to achieve these outcomes in every day clinical practice.