Rituximab is more effective than second anti-TNF therapy in rheumatoid arthritis patients and previous TNFα blocker failure Full Text
Biologics: targets & therapy, 07/23/2012
Kekow J et al. – Treatment with rituximab was more effective than a second TNF(alpha) blocker therapy in rheumatoid arthritis patients after failure of the first TNF(alpha) blocker. It was found that anti–cyclic citrullinated peptide antibodies may be a useful predictive biomarker for response to rituximab in patients with TNF(alpha) blocker treatment failure.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 TNF(alpha) blocker therapy, and were followed over 6.6 months on average after switching to rituximab versus a second TNF(alpha) blocker (ie, switching to etanercept, adalimumab, or infliximab) at baseline.
- 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 TNF(Alpha) 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 TNF(alpha) 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).