In a nutshell
The authors aimed to compare the effectiveness of rituximab (Rituxan) with a tumor necrosis factor inhibitor in the treatment of rheumatoid arthritis.
Some background
In rheumatoid arthritis (RA), the immune system begins attacking healthy tissue the way it normally attacks viruses or bacteria. This can cause inflammation, leading to chronic pain. Tumor necrosis factors (TNF) are proteins involved in the inflammation process in RA. TNF inhibitors (TNFi) block the action of TNF and prevent inflammation. However, the effectiveness of TNFi varies from patient to patient. Studies have shown that about 40% patients fail to respond to this therapy. Treatment failure may be due to non-response (drug does not have an effect anymore) or due to side effects. Switching to an alternate biological treatment such as rituximab can be effective in patients who fail to respond to TNFi treatment.
However, data comparing effectiveness of switching therapies are limited. More studies will be required to identify an appropriate treatment option.
Methods & findings
In the current study, the effectiveness of rituximab was compared to a second TNFi in RA patients who had failed to respond to or could not tolerate initial TNFi treatment.
Data from 728 patients were included in this study. Patients who were non-responsive or intolerant to single TNFi therapy were given either rituximab or a second TNFi. 405 patients received rituximab (Group 1). 323 patients received an alternate TNFi (Group 2). The effectiveness of treatment was measured by the DAS28-3–ESR, which measures disease activity in 28 joints excluding the erythrocyte sedimentation rate (ESR, an indication of the level of inflammation in the body). The lower the score on the DAS28-3–ESR, the greater the improvement following treatment.
After 6 months of treatment, the DAS28-3–ESR score decreased by 1.5 points in patients in group 1 compared to a decrease of 1.1 points in group 2. In group 1 patients who did not respond to the initial TNFi, the DAS28-3–ESR score decreased by 1.7 points compared to a score decrease of 1.3 points in group 2. There was no significant difference between the treatments in patients who were intolerant to the initial TNF1. RA patients in Group 1 who were positive for rheumatoid factor (protein present in the blood of some RA patients) had a greater decrease in the DAS28-3–ESR (1.6 points) compared to patients in Group 2 (1.2 point decrease).
The bottom line
The authors concluded that switching to rituximab was more effective compared with switching to a second TNFi.
The fine print
This study did not assess the effectiveness of rituximab and TNFi therapy in RA patients who were RF negative.
What’s next?
Consult with your physician regarding the treatment options available after failing TNFi therapy.
Published By :
Annals of the rheumatic diseases
Date :
Jun 01, 2015
