Rituximab for the treatment of rheumatoid arthritis

The authors analyzed the effectiveness of rituximab (Rituxan – a biological therapy) for the treatment of rheumatoid arthritis (RA) patients previously treated with another biological therapy. 

In RA, high levels of immune system proteins are generated. This causes inflammation, leading to chronic pain. Disease-modifying antirheumatic drugs (DMARDs) are safe and effective treatments used in patients with RA. Patients who do not respond to DMARDs are treated by anti-tumor necrosis factors (anti-TNF).

TNF refers to a group of proteins involved in the RA inflammation process . Anti-TNF treatment blocks the action of TNF and prevents inflammation. However, the effectiveness of anti-TNF treatment varies from patient to patient. Switching to an alternative biological treatment such as rituximab may be effective in patients who fail to respond to anti-TNF treatment.

Further studies on the effectiveness of rituximab in RA are needed to determine the appropriate treatment option. 

The authors aimed to analyze the effectiveness of rituximab in RA patients previously treated with an anti-TNF drug.

265 patients were included in this study. All patients were first time users of rituximab. Outcome was based on the clinical disease activity index (CDAI). This is a combination of different scoring systems used to assess joint function. A score of 2.8 or less is considered remission (reduction in RA signs and symptoms). A score between 2.8 and 10 is considered low disease activity. A score between 10 and 22 is considered moderate disease activity and a CDAI score above 22 is considered high disease activity. Achievement of remission was evaluated for all patients after 12 months. Low disease activity was measured for those who had moderate or high disease activity at the beginning of the study.

On average, the CDAI score was lowered by 8.1 at the end of the study in all patients. Of the 218 patients with moderate/high disease activity at the beginning of the study, patients who had previously been treated with anti-TNF therapy experienced a CDAI score lowering of 10.1. Patients who received more than two treatments with anti-TNF therapies experienced a CDAI score lowering of 10.5. Patients with moderate to high disease activity at the beginning of the study and who received one previous anti-TNF treatment experienced a 60% increase in the odds of achieving low disease activity or remission compared to patients who received more than two previous anti-TNF treatments. 

The authors concluded that rituximab produced low disease activity or remission in moderate to high disease activity RA patients who received one previous anti-TNF therapy.