Effectiveness of Rituximab in Patients with Rheumatoid Arthritis: Observational Study from the British Society for Rheumatology Biologics Register

Abstract

ABSTRACT. Objective. To assess the effectiveness of rituximab (RTX) in patients with rheumatoid arthritis (RA) in routine clinical practice, and to identify predictors of 6-month response to RTX in patients for whom at least 1 anti-tumor necrosis factor-α (anti-TNF) therapy has failed. Method. The analysis involved 646 patients with RA registered with the British Society for Rheumatology Biologics Register (BSRBR) who were starting RTX and were followed for at least 6 months. Change in the 28-joint Disease Activity Score (DAS28), European League Against Rheumatism (EULAR) response, and proportions of patients achieving disease remission were used to assess the clinical response 6 months after starting RTX. Regression analyses were used to identify factors associated with the response in the patients for whom anti-TNF therapy had not worked. The models included baseline demographics, disease characteristics, baseline Health Assessment Questionnaire (HAQ), and drug history including biologic history.Results. The mean DAS28 at baseline was 6.2 (95% CI 6.1, 6.3), which decreased significantly to 4.8 (95% CI 4.7, 4.9) at the 6-month followup. Seventeen percent of the patients were EULAR good responders and 43% were moderate responders. Eight percent of the patients achieved disease remission. Subjects with higher baseline DAS28 score and those with positive rheumatoid factor (RF) status were significantly associated with a decrease in their DAS28 score (improvement), while women and patients with higher baseline HAQ score were less likely to improve. Conclusion. RTX has proven to be effective in routine clinical practice. When anti-TNF therapy fails, response to RTX was influenced by baseline DAS28 score, RF status, baseline HAQ score, and sex.

Biological therapy for rheumatoid arthritis: is personalised medicine possible?

“…An observational study from the BSRBR found no significant differences between RF-positive and RF-negative patients and response to rituximab. However, when the analysis was limited to those patients who had failed to respond to a previous anti-TNFα agent, a greater reduction in DAS28 was seen in RF-positive than RF-negative patients, although this did not correlate with a good/moderate EULAR response14 A summary of these studies is included in online supplementary table S2.…”

Body Mass Index and response to rituximab in rheumatoid arthritis

“…BMI might be a predictive factor of IFX response in RA, but no study has evaluated the impact of BMI on rituximab (RTX) response in RA. Anti-CCP and RF positivity were found to be associated with better response to RTX [20][21][22]. Moreover, we recently published data of the same RA population suggesting that high anti-CCP titres could be associated with response to RTX [23].…”

Effectiveness of Rituximab for the Treatment of Rheumatoid Arthritis in Patients with Prior Exposure to Anti-TNF: Results from the CORRONA Registry

“…In clinical practice, many patients initiating RTX have lower disease activity levels compared with those enrolled in anti-TNF RCT, a factor that further influences evaluations of effectiveness 12,13,14 . Most observational data examining the effectiveness of RTX in routine clinical practice have been reported from European registries 15,16,17,18,19,20,21,22 , with scant information currently available from the United States 23 . There is tremendous value in examining US cohorts of patients with RA to assess effectiveness because of the differences in treatment practices and patient characteristics.…”