Rheumatology Advance Access published online on September 29, 2009
Rheumatology, doi:10.1093/rheumatology/kep314
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Rheumatoid factor positivity rather than anti-CCP positivity, a lower disability and a lower number of anti-TNF agents failed are associated with response to rituximab in rheumatoid arthritis
1Clinica di Reumatologia, DPMSC, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", University of Udine, Udine, 2U.O. di Reumatologia, Azienda Ospedaliera Polo Universitario L. Sacco, Milano, 3U.O.A. di Reumatologia, Ospedale Mauriziano di Torino, Torino, 4U.O.S di Reumatologia, Nuovo Ospedale S. Giovanni di Dio, Firenze, 5Clinica di Reumatologia, University of Genova, Genova and 6S.S. di Reumatologia, S.C. III Medica, Azienda Ospedaliera "Ospedali Riuniti", Trieste, Italy.
Correspondence to:
Salvatore De Vita, Rheumatology Clinic, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", University of Udine, P.z.le S. Maria della Misericordia 15, 33100 Udine, Italy. E-mail: devita.salvatore{at}aoud.sanita.fvg.it
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Abstract |
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Objectives. We explored clinical factors associated with a major response to rituximab (RTX) (e.g. ACR 
50, and European League against Rheumatism (EULAR) moderate to good response) in patients with active long-standing RA and inadequate response to anti-TNF agents or traditional DMARDs.
Methods. RTX was used in 110 RA patients in six different Italian centres. The mean disease activity score on 28 joints (DAS28) was 6.4 ± 0.99 and the mean HAQ was 1.63 ± 0.68 at baseline. Thirty-two patients (29.1%) underwent RTX after the failure of DMARD therapy, 37 (33.6%) had failed or were intolerant to at least two anti-TNF agents, and 41 (37.3%) had failed or were intolerant to one anti-TNF agent. Univariate and multivariate analyses were performed.
Results. The number of previous anti-TNF agents (P = 0.043), HAQ (P = 0.023), RF positivity (P < 0.0001) and anti-cyclic citrullinated peptide (anti-CCP) positivity (P = 0.003) were associated with ACR response 50 between month +4 and month +6 after starting RTX by univariate analysis. Multivariate analysis confirmed that a lower HAQ, a lower number of anti-TNF agents failed before RTX and RF positivity, but not anti-CCP positivity, were the selected variables associated with an ACR response 50, with an accuracy of 84% of the model. Only RF positivity correlated with EULAR moderate to good response both in the univariate and in the multivariate analysis, with an accuracy of 79% of the model.
Conclusion. RF-positive rather than anti-CCP-positive RA patients with lower baseline disability and a lower number of previously failed TNF blockers may be the best candidates to RTX.
KEY WORDS: Rheumatoid arthritis, Rituximab, Rheumatoid factor, Anti-CCP, Anti-TNF, DMARDs
Submitted 6 April 2009;
revised version accepted 27 August 2009.
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