Rituximab and the risk of infections in rheumatoid arthritis

This study investigated the long-term safety of rituximab (Rituxan) in patients with rheumatoid arthritis (RA).

They found that the rate of infections did not increase with prolonged rituximab treatment.

Treating rheumatoid arthritis (RA) involves taking medication to reduce symptoms. RA is caused by inflammation and is a chronic disease. This means that RA patients will take medications for long periods of time. As a result, it is important that any RA medication is safe for long-term treatment.

Rituximab (RXB) is a new drug to treat RA. It is a biological drug or bDMARD. DMARDs are disease-modifying anti-rheumatic drugs. RXB works by binding to a marker called CD20, on the surface B cells. B cells are part of our immune system. In people without inflammatory conditions, they help the body respond to any invader or sources of infection. In RA, B cells are over-activated and produce chemicals that cause excess inflammation. RXB can help reduce inflammation in RA patients. It is unclear if long-term RXB use can increase the risk of infection in RA.

This study included 989 patients with RA. RXB was administered as an infusion (slow injection into the vein). Each patient received RXB in two infusions separated by 2 weeks. This was repeated every 16-24 weeks. Patients were also treated with other RA medications. Patients were followed for up to 5 years.

20% of patients reported at least one infection during the follow-up period. 8% of patients reported 2 or more infections during follow-up. 86% of infections were considered serious and required hospitalization. Common infections included pneumonia, cellulitis (skin infection), sepsis (infection in the bloodstream), and bronchitis. The rate of infections did not increase over time from the beginning of RXB treatment.

The authors concluded that the rate of infections did not increase with prolonged RXB treatment.

RXB treatment varied between patients. Patients were also treated with other RA medication. As a result, the rate of infection might vary between patients.  

If you have any concerns regarding rheumatoid arthritis treatment, please consult with your physician.