Disease activity–guided rituximab therapy in rheumatoid arthritis: The effects of re‐treatment in initial nonresponders versus initial responders
Open Access
- 26 November 2008
- journal article
- clinical trial
- Published by Wiley in Arthritis & Rheumatism
- Vol. 58 (12), 3657-3664
- https://doi.org/10.1002/art.24035
Abstract
Objective To explore the efficacy of re‐treatment with rituximab in patients with rheumatoid arthritis (RA) who were initial nonresponders to treatment, and to evaluate the effects of rituximab in RA when re‐treatment is given in a standardized way based on the Disease Activity Score in 28 joints (DAS28), according to the international consensus statement. Methods Patients with RA who had a DAS28 of ≥3.2 received up to 3 courses of rituximab at intervals of at least 6 months, regardless of whether the patient had responded to the first course of treatment with rituximab. Results Of the 30 patients with RA who were included in the study, 26 could be evaluated for the efficacy of treatment after 6 months. Eighteen patients qualified for re‐treatment at 6 months, 6 patients were re‐treated at a later time point because of a disease relapse, and 2 other patients were not re‐treated because they had low disease activity. Seven of the 24 patients who qualified for re‐treatment had not exhibited clinical improvement after the first treatment course. These patients typically did not respond to subsequent courses of rituximab. Of interest, in the 17 patients who had exhibited a clinical response to the first course of rituximab, the second and third treatment courses resulted in European League Against Rheumatism responses similar to those observed after the first course, and no major relapses occurred before re‐treatment. Conclusion Rituximab re‐treatment is not effective in patients who do not exhibit clinical improvement after the first treatment course, which is consistent with the notion that such patients represent a different pathogenetic subset of RA. Patients who initially responded to rituximab treatment experienced sustained benefit from DAS28‐based systematic re‐treatment according to the international consensus statement.Keywords
This publication has 26 references indexed in Scilit:
- Immunohistochemical analysis as a means to predict responsiveness to rituximab treatmentArthritis & Rheumatism, 2007
- Assessment of rituximab's immunomodulatory synovial effects (ARISE trial). 1: clinical and synovial biomarker resultsAnnals Of The Rheumatic Diseases, 2007
- Synovial tissue response to rituximab: mechanism of action and identification of biomarkers of responseAnnals Of The Rheumatic Diseases, 2007
- The Efficacy of Rituximab plus Hyper-CVAD Regimen in Mantle Cell Lymphoma Is Independent of FCγRIIIa and FCγRIIa PolymorphismsJournal of Chemotherapy, 2007
- Early effects of rituximab on the synovial cell infiltrate in patients with rheumatoid arthritisArthritis & Rheumatism, 2007
- Rituximab for rheumatoid arthritis refractory to anti–tumor necrosis factor therapy: Results of a multicenter, randomized, double‐blind, placebo‐controlled, phase III trial evaluating primary efficacy and safety at twenty‐four weeksArthritis & Rheumatism, 2006
- Consensus statement on the use of rituximab in patients with rheumatoid arthritisAnnals Of The Rheumatic Diseases, 2006
- The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: Results of a phase IIB randomized, double‐blind, placebo‐controlled, dose‐ranging trialArthritis & Rheumatism, 2006
- Efficacy of B-Cell–Targeted Therapy with Rituximab in Patients with Rheumatoid ArthritisNew England Journal of Medicine, 2004
- Do self‐perpetuating B lymphocytes drive human autoimmune disease?Immunology, 1999