Comparative Study of Infliximab Therapy and Methotrexate Monotherapy to Improve the Clinical Effect in Rheumatoid Arthritis Patients

Abstract

Objective We examined whether infliximab (IFX) therapy was more effective than methotrexate (MTX) monotherapy to achieve an improvement in depressive states in Rheumatoid Arthritis (RA) patients. Methods We examined 152 RA patients (72 IFX patients and 80 MTX patients).We conducted an openlabel cohort study to evaluate the disease activity of RA (Simplified Disease Activity Index; SDAI), depressive states (Hamilton Rating Scale for Depression; HAM-D), Activity of Daily Living (ADL) (modified Health Assessment Questionnaire; mHAQ) and Quality of Life (QOL) [Short Form (SF)-36] in patients before and 6 months after receiving therapy. The HAM-D, SDAI, mHAQ and SF-36 scores after 6 months of therapy were measured as the outcomes. Results We analyzed 60 IFX patients and 53 MTX patients. The HAM-D scores significantly improved in both groups (p<0.001), but there was no significant difference in the effectiveness between the IFX and MTX therapies (p=0.792). The SDAI scores significantly improved in both groups after therapy (p<0.001), and IFX therapy was more effective than MTX therapy (p=0.004). The mHAQ and HAM-D scores also improved significantly in both groups after therapy (p<0.001), but no significant difference in the effectiveness between the IFX and MTX therapies was observed (p=0.272, 0.792). The scores of all 8 items of the SF-36 improved in both groups after therapy, but IFX therapy was more effective than MTX therapy in only 4 of the 8 items (p<0.05). Conclusion Both IFX and MTX therapy improved the clinical efficacy, ADL, QOL and depressive states. However, no significant differences regarding an improvement in the depressive states and ADL were observed between IFX therapy and MTX monotherapy.

Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review

“…RA is treated with conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs), biologic (b) DMARDs, targeted synthetic (ts) DMARDs and glucocorticoids [8]. An open-label cohort study found that bDMARDs improve depression in RA patients [75]. Another prospective single-blinded study reported that csDMARDs and bDMARDs have a similar effect on improving depressive symptoms in RA patients [76].…”

The Relationship between the Serum Oxytocin Levels, Disease Activity, the ADLs and the QOL in Patients with Rheumatoid Arthritis

“…We analyzed ( 1 ) the differences in background characteristics due to the presence or absence of depression ( 2 ), the correlation coefficients between HAM-D and the other factors ( 3 ), the correlation coefficients between the serum OXT levels and other factors, and ( 4 ) the serum OXT levels before and after bDMARD treatment. The following statistical analyses were performed: a Mann-Whitney U test, chi-squared test, Pearson's moment correlation coefficient and a repeated-measure analysis of variance (ANOVA).…”

“…The odds ratio for depression in RA patients was 1.42 (95% confidence interval (CI): 1.3, 1.5; relative to healthy individuals) ( 2 ). The treatment of RA with biological disease-modifying antirheumatic drugs (bDMARDs) is known to be highly effective in reducing the disease activity as well as the severity of depression that occurs in association with RA ( 3 ).…”

Effect of immunomodulating treatment (usage of DMARDs) in rheumatoid arthritis on depression

“…Comparative study of monoteraphy of methotrexate vs. infliximab showed that both groups of patients taking one or the other drug had a lower likelihood of depression. Given the Hamilton Rating Scale for Depression (HAM-D) and Disease Activity Score (DAS), there was no statistical difference between them [31,32], and on the Self-Rating Depression Scale (SDS) there was a statistical difference between them in favor of infliximab [32]. However, in RA therapy alone, imfliximab was significantly more effective than monotrexate alone [31].…”