Rituximab is more effective than second anti-TNF therapy in rheumatoid arthritis patients and previous TNFα blocker failure
Open Access
- 1 July 2012
- journal article
- Published by Informa UK Limited in Biologics: Targets and Therapy
- Vol. 6, 191-199
- https://doi.org/10.2147/btt.s32244
Abstract
Purpose: To assess the efficacy of one course of rituximab (two 1-g doses) compared to an alternative tumor necrosis factor-α (TNFα) blocker in rheumatoid arthritis patients who had experienced one previous TNFα blocker failure (eg, etanercept, adalimumab, or infliximab). Patients and methods: The efficacy of both treatments was studied in this retrospective, multicenter, noninterventional cohort study with 196 patients. All patients had active rheumatoid arthritis defined by a Disease Activity Score-28 of ≥3.2 despite having TNFα blocker therapy, and were followed over 6.6 months on average after switching to rituximab versus a second TNFα blocker (ie, switching to etanercept, adalimumab, or infliximab) at baseline. Results: At baseline, both cohorts showed similar demographic and disease-related characteristics (including Disease Activity Score-28). At the end of observation, mean Disease Activity Score-28 was significantly lower after treatment with rituximab than with a second TNFα blocker (-1.64 [95% confidence interval: -1.92; -1.36] versus -1.19 [95% confidence interval: -1.42; -0.96], P = 0.013). This difference between the two groups was even more pronounced when patients were seropositive for rheumatoid factor (-1.66 versus -1.17, P = 0.018) and anti-cyclic citrullinated peptide antibodies (-1.75 versus -1.06, P = 0.002). More rituximab-treated patients achieved good European League Against Rheumatism response than TNFα blocker-treated patients (30% versus 15%), and less patients were nonresponders (22% versus 35%) according to European League Against Rheumatism criteria (P = 0.022, chi-squared test). Conclusion: Treatment with rituximab was more effective than a second TNFα blocker therapy in rheumatoid arthritis patients after failure of the first TNFα blocker. It was found that anti-cyclic citrullinated peptide antibodies may be a useful predictive biomarker for response to rituximab in patients with TNFα blocker treatment failure.Keywords
This publication has 25 references indexed in Scilit:
- Drug combinations with methotrexate to treat rheumatoid arthritis.2010
- State-of-the-art: rheumatoid arthritis: Figure 1Annals Of The Rheumatic Diseases, 2010
- The impact of rheumatoid arthritis and treatment on patients' lives.2010
- Improvement in patient‐reported outcomes in a rituximab trial in patients with severe rheumatoid arthritis refractory to anti–tumor necrosis factor therapyArthritis Care & Research, 2008
- 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
- Once‐weekly administration of 50 mg etanercept in patients with active rheumatoid arthritis: Results of a multicenter, randomized, double‐blind, placebo‐controlled trialArthritis & Rheumatism, 2004
- Rheumatoid arthritis therapy after tumor necrosis factor and interleukin‐1 blockadeArthritis & Rheumatism, 2003
- Adalimumab, a fully human anti–tumor necrosis factor α monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: The ARMADA trialArthritis & Rheumatism, 2003
- Anti‐TNF agents for rheumatoid arthritisBritish Journal of Clinical Pharmacology, 2001
- Infliximab and Methotrexate in the Treatment of Rheumatoid ArthritisNew England Journal of Medicine, 2000