RESEARCH - Response to rituximab associated with RF positivity rather than anti-CCP positivity, lower disability, and a lower number of anti-TNF agents failed

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Rheumatology Advance Access published online on September 29, 2009

Rheumatology, doi:10.1093/rheumatology/kep314

Rheumatoid factor positivity rather than anti-CCP positivity, a lower

disability and a lower number of anti-TNF agents failed are associated

with response to rituximab in rheumatoid arthritis

Luca Quartuccio1, a Fabris1, Sara Salvin1, Fabiola Atzeni2,

Marta Saracco3, Maurizio Benucci4, Marco Cimmino5, Pia Morassi6, Paola

Masolini1, Raffaele Pellerito3, Maurizio Cutolo5, Piercarlo Sarzi

Puttini2 and Salvatore De Vita1

1Clinica di Reumatologia, DPMSC, Azienda Ospedaliero-Universitaria " S.

della Misericordia " , University of Udine, Udine, 2U.O. di

Reumatologia, Azienda Ospedaliera Polo Universitario L. Sacco, Milano,

3U.O.A. di Reumatologia, Ospedale Mauriziano di Torino, Torino, 4U.O.S

di Reumatologia, Nuovo Ospedale S. Giovanni di Dio, Firenze, 5Clinica

di Reumatologia, University of Genova, Genova and 6S.S. di

Reumatologia, S.C. III Medica, Azienda Ospedaliera " Ospedali Riuniti " ,

Trieste, Italy.

Abstract

Objectives. We explored clinical factors associated with a major

response to rituximab (RTX) (e.g. ACR 50, and European League against

Rheumatism (EULAR) moderate to good response) in patients with active

long-standing RA and inadequate response to anti-TNF agents or

traditional DMARDs.

Methods. RTX was used in 110 RA patients in six different Italian

centres. The mean disease activity score on 28 joints (DAS28) was 6.4

± 0.99 and the mean HAQ was 1.63 ± 0.68 at baseline. Thirty-two

patients (29.1%) underwent RTX after the failure of DMARD therapy, 37

(33.6%) had failed or were intolerant to at least two anti-TNF agents,

and 41 (37.3%) had failed or were intolerant to one anti-TNF agent.

Univariate and multivariate analyses were performed.

Results. The number of previous anti-TNF agents (P = 0.043), HAQ (P =

0.023), RF positivity (P < 0.0001) and anti-cyclic citrullinated

peptide (anti-CCP) positivity (P = 0.003) were associated with ACR

response 50 between month +4 and month +6 after starting RTX by

univariate analysis. Multivariate analysis confirmed that a lower HAQ,

a lower number of anti-TNF agents failed before RTX and RF positivity,

but not anti-CCP positivity, were the selected variables associated

with an ACR response 50, with an accuracy of 84% of the model. Only RF

positivity correlated with EULAR moderate to good response both in the

univariate and in the multivariate analysis, with an accuracy of 79%

of the model.

Conclusion. RF-positive rather than anti-CCP-positive RA patients with

lower baseline disability and a lower number of previously failed TNF

blockers may be the best candidates to RTX.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep314v1?papetoc

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