Rituximab or a second anti-TNF therapy for rheumatoid arthritis patients who have failed their first anti-TNF? Comparative analysis from the British Society for Rheumatology Biologics Register

Arthritis Care & Research , 05/07/2012

Soliman MM et al. – The results suggest that switching to rituximab (RTX) may be of more benefit to switching to an alternative anti–tumour necrosis factor (anti–TNF) therapy after failing the first anti–TNF in Rheumatoid arthritis (RA) patients.


  • RA patients were registered with the British Society for Rheumatology Biologics Register.
  • Response to treatment six months after switching was assessed using:
    • (1) European League Against Rheumatism (EULAR) criteria
    • (2) improvements in Health Assessment Questionnaire (HAQ) score (0.22 units or more).
  • Regressionanalysis was used to compare EULAR response and improvement in HAQ between the two groups, adjusting for propensity scores.


  • In total, 1328 patients were included in the analysis of EULAR response and 937 patients were included inthe analysis of HAQ score.
  • Six months after switching, 54.8% of patients who switched to RTX were EULAR responders compared to 47.3% of those who switched to a second anti–TNF.
  • 38.4% of RTX patients achieved a clinically important improvement in HAQ compared to 29.6% in anti–TNF patients.
  • After adjustment using propensity scores, patients who switched to RTX were significantly more likely to achieve EULAR response; OR (95% CI) 1.31 (1.02, 1.69) compared to those who switched to an alternative anti–TNF.
  • RTX patients were also significantly more likely to achieve improvements in HAQ; (OR (95% CI) 1.49 (1.07, 2.08).

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