RESEARCH - B cell depletion with rituximab may be more effective than switching to an alternative anti-TNF agent in RA

January 11, 2008

Arthritis Rheum. 2007 May;56(5):1417-23.

B cell depletion may be more effective than switching to an alternative

anti-tumor necrosis factor agent in rheumatoid arthritis patients with

inadequate response to anti-tumor necrosis factor agents.

Finckh A, Ciurea A, Brulhart L, Kyburz D, Möller B, Dehler S, Revaz S,

Dudler J, Gabay C; Physicians of the Swiss Clinical Quality Management

Program for Rheumatoid Arthritis.

University Hospital of Geneva, Geneva, Switzerland

OBJECTIVE: Patients with rheumatoid arthritis (RA) in whom the response to

anti-tumor necrosis factor (anti-TNF) therapy is inadequate have several

therapeutic options, such as switching to an alternative anti-TNF agent or

initiating B cell-depleting therapy with rituximab (RTX). Although both

therapeutic options have been proven effective in trials, no head-to-head

comparisons are available. The aim of this study was to compare the

effectiveness of RTX with that of an alternative anti-TNF agent in the

management of patients with RA who had an inadequate response to anti-TNF

therapy. METHODS: This prospective cohort study was nested within the Swiss

Clinical Quality Management RA cohort and included all patients who had an

inadequate response to at least 1 anti-TNF agent and subsequently received

either 1 cycle of RTX or an alternative anti-TNF agent. The primary outcome

was the evolution of RA disease activity (as measured on the Disease

Activity Score in 28 joints [DAS28]), which was analyzed using multivariate

regression models for longitudinal data. RESULTS: One hundred sixteen

patients with RA were included; 50 patients received 1 cycle of RTX, and 66

patients were treated with a second or a third alternative anti-TNF agent.

At baseline, there were no significant differences between the 2 groups in

age, sex, disease duration, and disease activity. Evolution of the DAS28 was

more favorable in the group that received RTX compared with the group that

received an alternative anti-TNF agent (P = 0.01). At 6 months, the mean

decrease in the DAS28 was -1.61 (95% confidence interval [95% CI] -1.97,

-1.25) among patients receiving RTX and -0.98 (95% CI -1.33, -0.62) among

those receiving subsequent anti-TNF therapy. CONCLUSION: The results of this

observational study suggest that treatment with RTX may be more effective

than switching to an alternative anti-TNF agent in patients with RA in whom

active disease persists despite anti-TNF therapy.

PMID: 17469098

PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Not an MD

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