RESEARCH - Which subgroup of RA patients benefits from switching to rituximab versus alternative anti-TNF agents after previous failure of an anti-TNF agent?

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Ann Rheum Dis. Published Online First: 4 May 2009. doi:10.1136/ard.2008.105064

BMJ Publishing Group Ltd & European League Against Rheumatism.

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Extended Report

Which subgroup of rheumatoid arthritis patients benefits from

switching to rituximab versus alternative anti-TNF agents after

previous failure to anti-TNF agent?

Axel Finckh 1*, Ciurea 2, Laure Brulhart 1, Diego Kyburz 2,

Burkhard Moeller 3, Ulrich A 4, Delphine Courvoisier 1, Jean

Dudler 5 and Cem Gabay 1

1 University Hospital of Geneva, Switzerland

2 University Hospital of Zurich, Switzerland

3 University Hospital of Bern, Switzerland

4 University Hospital of Basel, Switzerland

5 University Hospital of Vaud, Switzerland

Abstract

Background: Rheumatoid arthritis (RA) patients with an inadequate

response to TNF inhibitors (aTNF) may switch to an alternative aTNF or

start a treatment from a different class, such as rituximab (RTX). It

remains unclear in which clinical settings these therapeutic

strategies offer most benefit.

Objective: To analyze the effectiveness of RTX versus alternative

aTNFs on RA disease activity in different subgroups of patients.

Methods: This is a prospective cohort study of RA patients who

discontinued at least one aTNF and subsequently received either RTX or

an alternative aTNF, nested within the Swiss RA registry (SCQM-RA).

The primary outcome, longitudinal improvement in DAS28, was analysed

using multivariate regression models for longitudinal data and

adjusted for potential confounders.

Results: Of the 318 RA patients included; 155 received RTX and 163

received an alternative aTNF. The relative benefit of RTX varied with

the type of prior aTNF failure: when the motive for switching was

ineffectiveness to previous aTNFs, the longitudinal improvement in

DAS28 was significantly better with RTX than alternative aTNF (p =

0.03; at 6 months, –1.34 (95% CI: –1.54; –1.15) versus –0.93 (95% CI:

–1.28; –0.59) respectively). When the motive for switching was other

causes, the longitudinal improvement in DAS28 was similar between RTX

and alternative aTNFs (p =0.40). These results were not significantly

modified by the number of previous aTNF failures, the type of aTNF

switches, or the presence of DMARD co-therapy.

Conclusion: This observational study suggests that RTX is more

effective than switching to an alternative aTNF in RA patients who

stopped a previous aTNF treatment because of ineffectiveness.

http://ard.bmj.com/cgi/content/abstract/ard.2008.105064v1?papetoc

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