RESEARCH - Which subgroup of RA patients benefits from switching to rituximab instead of another anti-TNF agent?

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Ann Rheum Dis 2010;69:387-393 doi:10.1136/ard.2008.105064

Clinical and epidemiological research

Extended report

Which subgroup of patients with rheumatoid arthritis benefits from

switching to rituximab versus alternative anti-tumour necrosis factor

(TNF) agents after previous failure of an anti-TNF agent?

A Finckh1, A Ciurea2, L Brulhart1, B Möller3, U A 4, D

Courvoisier5, D Kyburz2, J Dudler6, C Gabay1, on the behalf of the

doctors of the Swiss Clinical Quality Management Programme for

Rheumatoid Arthritis

+ Author Affiliations

1Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland

2Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland

3Department of Rheumatology, Clinical Immunology and Allergy,

University Hospital of Bern, Bern, Switzerland

4Division of Rheumatology, University Hospital of Basel, Basel, Switzerland

5Division of Clinical Epidemiology, University Hospital of Geneva,

Geneva, Switzerland

6Division of Rheumatology, University Hospital of Lausanne, Lausanne,

Switzerland

Abstract

Background: Patients with rheumatoid arthritis (RA) with an inadequate

response to TNF antagonists (aTNFs) may switch to an alternative aTNF

or start treatment from a different class of drugs, such as rituximab

(RTX). It remains unclear in which clinical settings these therapeutic

strategies offer most benefit.

Objective: To analyse the effectiveness of RTX versus alternative

aTNFs on RA disease activity in different subgroups of patients.

Methods: A prospective cohort study of patients with RA who

discontinued at least one aTNF and subsequently received either RTX or

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

carried out. The primary outcome, longitudinal improvement in 28-joint

count Disease Activity Score (DAS28), was analysed using multivariate

regression models for longitudinal data and adjusted for potential

confounders.

Results: Of the 318 patients with RA 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 with an alternative aTNF

(p = 0.03; at 6 months, −1.34 (95% CI −1.54 to −1.15) vs −0.93 (95%

CI

−1.28 to −0.59), respectively). When the motive for switching was

other causes, the longitudinal improvement in DAS28 was similar for

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 co-treatment with a

disease-modifying antirheumatic drug.

Conclusion: This observational study suggests that in patients with RA

who have stopped a previous aTNF treatment because of ineffectiveness

changing to RTX is more effective than switching to an alternative

aTNF.

http://ard.bmj.com/content/69/2/387.abstract?etoc

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