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. 2009 May 4.

Which subgroup of rheumatoid arthritis patients benefits from

switching to rituximab versus alternative anti-TNF agents after

previous failure to anti-TNF agent?

Finckh A, Ciurea A, Brulhart L, Kyburz D, Moeller B, UA,

Courvoisier D, Dudler J, Gabay C.

University Hospital of Geneva, Switzerland.

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.

PMID: 19416802

http://www.ncbi.nlm.nih.gov/pubmed/19416802

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