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Expanded Labeling for Infliximab Includes First Line Regimen To Treat Moderate to Severe Rheumatoid Arthritis

Centocor, Inc. announced today that the U.S. Food and Drug Administration (FDA) has approved an expanded label for REMICADE® (infliximab) in combination with methotrexate (REMICADE regimen), as a first line regimen to treat patients with moderate to severe rheumatoid arthritis (RA). The expanded label eliminates the requirement that patients must fail to respond to methotrexate, the current standard of treatment for RA, before starting on the REMICADE regimen. These patients can now benefit from treatment with the REMICADE regimen, which has been shown to reduce signs and symptoms, inhibit further joint destruction and improve physical function.

Intervention early is critical to change the course of joint destruction in this debilitating disease. In the ASPIRE (Active Controlled Study of Patients Receiving Infliximab for Treatment of Rheumatoid Arthritis of Early Onset) study, more than 80 percent of patients had evidence of erosive joint damage despite the fact that the median disease duration was only 7 months. This study demonstrated that the REMICADE regimen was superior to methotrexate alone in changing the course of the disease when given early. The majority of patients treated with the REMICADE regimen experienced no progression of structural damage while the majority of patients treated with methotrexate alone progressed significantly despite titration to high doses of methotrexate.

"The ASPIRE trial demonstrated that with early, intensive intervention patients can achieve substantial symptomatic improvement," said David E. Yocum, MD, director, Arizona Arthritis Center, the University of Arizona College of Medicine, and ASPIRE investigator. "Moreover, in a subset of patients without joint damage at baseline, REMICADE plus methotrexate provided greater benefit than methotrexate alone in maintaining an erosion free state. To date, no other anti-TNF combination regimen has been shown to be more effective than methotrexate alone in stopping joint damage in patients with early disease."

"The ASPIRE data confirm that treating patients early in their disease with REMICADE can change the course of structural damage associated with RA," said Jerome A. Boscia, MD, senior vice-president, Clinical Research and Development, Centocor. "The magnitude of benefit seen with the REMICADE regimen and its effect on joint progression was a key factor in the approval of this new indication. The approval further confirms the positive benefit to risk profile of REMICADE."

The FDA approval is based on the results of ASPIRE, the largest controlled trial ever conducted exclusively in RA patients with early disease, (less than or equal to 3 years duration), which found REMICADE plus methotrexate to be superior to methotrexate alone in patients with moderately to severely active disease. ASPIRE was a 54-week, randomized, double blind, active control study involving 1,004 patients with early disease enrolled in 125 centers in North America and Europe. At randomization, all patients received methotrexate and either placebo, 3mg/kg of REMICADE or 6mg/kg of REMICADE at weeks 0, 2 and 6 and then every eight weeks thereafter. The ASPIRE trial demonstrated superiority of the REMICADE regimen over methotrexate alone on all three primary endpoints, including reduction of signs and symptoms, inhibition of the progression of structural damage and improvement in physical function.

The most commonly reported adverse events were upper respiratory infection, nausea and headache. Serious infections included pneumonia, TB and sepsis. Please read important information about REMICADE, including full prescribing information, at See "Important Information" below.

About Rheumatoid Arthritis
RA is a chronic, progressive disease, and research suggests that a critical therapeutic window may exist within the first two years of disease onset when the rate of radiographic progression of the disease can be "reset"(1,2,3). Radiographic changes occur within two years of disease onset in 50-70 percent of RA patients(4). The American College of Rheumatology (ACR) suggests control of disease progression should start early to limit joint damage in RA(3). RA is associated with substantial disability and economic losses, and one study showed that one-third of patients in the UK who were employed became work-disabled within two years of disease onset(5). Rheumatologic disorders also account for 25 percent of Social Security disability payments(6).

(1). Landewe RB, Boers M, Verhoeven AC, et al. COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum. 2002;46:347-356.
(2). Egsmose C, Lund B, Borg G, et al. Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year follow up of a prospective double blind placebo controlled study. J. Rheumatol. 1995;22:2208-2213.
(3). American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines, 2002 Update.
(4). van der Heijde DM. Joint erosions and patients with early rheumatoid arthritis. Br J Rheumatol. 1995;34(suppl 2):74-78.
(5). Barrett EM, Scott DGI, Wiles NJ, Symmons DPM. The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. Rheumatology. 2000;39:1403-1409.
(6). Social Security Disability Insurance Program.
(7). Data on file at Centocor.

Source: Centocor

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