Eight RCTs met inclusion criteria (n=3,699 patients). Three trials were excluded from the meta-analysis, as two trials used the same data and a third used data from a previous trial.
Four RCTs (n=1,647) assessed structural joint destruction based on van der Heijde-Sharp scores. These found a significant reduction in radiographic damage progression in favour of methotrexate-infliximab compared with methotrexate-placebo (standard deviation -4.1, 95% CI: 3.5 to 4.6).
The results of the RCTs comparing methotrexate-infliximab with methotrexate alone revealed modest improvements on measures of disease activity (Disease Activity Score, American College of Rheumatology response criteria). Three of the trials exhibited a benefit of methotrexate-infliximab on Health Assessment score. Patients improved their scores by 58% to 80% after one year of follow-up on methotrexate-infliximab combination and between 18% and 50% on methotrexate-placebo. Three trials reported treatment side-effects.