RESEARCH - Disease activity-guided rituximab therapy in RA

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Arthritis Rheum. 2008 Nov 26;58(12):3657-3664.

Disease activity-guided rituximab therapy in rheumatoid arthritis: The

effects of re-treatment in initial nonresponders versus initial

responders.

Thurlings RM, Vos K, Gerlag DM, Tak PP.

Academic Medical Center, and University of Amsterdam, Amsterdam, The

Netherlands.

OBJECTIVE: To explore the efficacy of re-treatment with rituximab in

patients with rheumatoid arthritis (RA) who were initial nonresponders

to treatment, and to evaluate the effects of rituximab in RA when

re-treatment is given in a standardized way based on the Disease

Activity Score in 28 joints (DAS28), according to the international

consensus statement.

METHODS: Patients with RA who had a DAS28 of >/=3.2 received up to 3

courses of rituximab at intervals of at least 6 months, regardless of

whether the patient had responded to the first course of treatment

with rituximab.

RESULTS: Of the 30 patients with RA who were included in the study, 26

could be evaluated for the efficacy of treatment after 6 months.

Eighteen patients qualified for re-treatment at 6 months, 6 patients

were re-treated at a later time point because of a disease relapse,

and 2 other patients were not re-treated because they had low disease

activity. Seven of the 24 patients who qualified for re-treatment had

not exhibited clinical improvement after the first treatment course.

These patients typically did not respond to subsequent courses of

rituximab. Of interest, in the 17 patients who had exhibited a

clinical response to the first course of rituximab, the second and

third treatment courses resulted in European League Against Rheumatism

responses similar to those observed after the first course, and no

major relapses occurred before re-treatment.

CONCLUSION: Rituximab re-treatment is not effective in patients who do

not exhibit clinical improvement after the first treatment course,

which is consistent with the notion that such patients represent a

different pathogenetic subset of RA. Patients who initially responded

to rituximab treatment experienced sustained benefit from DAS28-based

systematic re-treatment according to the international consensus

statement.

PMID: 19035505

http://www.ncbi.nlm.nih.gov/pubmed/19035505

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