Rheumatology Advance Access published online on March 23, 2007
Rheumatology, doi:10.1093/rheumatology/kel453
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Rituximab therapy in patients with resistant rheumatoid arthritis: real-life experience
Department of Rheumatology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK
Correspondence to:
R. N. Jois, Department of Rheumatology, East block, Level-2, Norfolk and Norwich University Hospital, Colney lane, Norwich NR4 7UY, UK. E-mail: rammi09{at}yahoo.com
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Abstract |
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Objectives. Rituximab has recently been shown to be effective in suppressing disease activity in patients with rheumatoid arthritis (RA) who fail anti-TNF therapy. We present our experience of treating patients with long-standing, multi-DMARD and anti-TNF resistant RA with rituximab in ‘real-life’ setting.
Methods. Patients with RA resistant to more than two anti-TNF drugs and with persistent disease activity (DAS28 > 5.1) were considered for treatment with rituximab (two infusions 1000 mg each, a fortnight apart). DAS28 and HAQ scores were performed at baseline, 3 and 6 months post-treatment. Response to rituximab was defined as per the EULAR response criteria. Re-treatment with a second cycle of rituximab was offered if they had responded to the earlier one but flared.
Results. Twenty patients received rituximab. Median disease duration was 16 yrs (range 5–39) and 90% were rheumatoid factor positive. Median number of biologics received pre-treatment was two (range 2–4). Rituximab treatment led to a significant reduction in DAS28 score (P < 0.0001) at 3 months and various other disease parameters. The benefit was sustained at 6 months. Moderate-to-good EULAR response was seen in 85% of patients at 3 months and 60% at 6 months. No significant side effects were observed. 50% of the patients flared and received re-treatment. Interval to re-treatment varied from 6 to 18 months. The majority of the RA patients responded to re-treatment with rituximab and no major side effects were observed.
Conclusion. Rituximab was effective in controlling disease activity in anti-TNF therapy resistant RA patients in ‘real-life’ setting. Rituximab was safe with no major side effects. Re-treatment with rituximab was safe and efficacy was maintained.
KEY WORDS: Rituximab, Rheumatoid arthritis
Submitted 29 November 2006;
revised version accepted 15 December 2006.
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