Long-term persistence of rituximab in patients with rheumatoid arthritis: an evaluation of the UCL cohort from 1998 to 2020

Abstract

Objectives B cell depletion therapy based on rituximab in patients with rheumatoid arthritis (RA) was pioneered at UCLH/UCL in 1998. The objective of this study was to evaluate long-term persistence of rituximab and identify factors associated with discontinuation of treatment. Methods Retrospective review of medical records from all rituximab-treated RA patients followed up in a dedicated clinic (1998–2020). Data collected included gender, disease duration, previous DMARDs, autoantibody status, age and concomitant therapy at first cycle, length of follow-up, number of cycles. Drug survival and factors associated with drug discontinuation were analysed using Kaplan-Meier survival curves, logrank test and Cox regression analysis. Results A total of 404 patients were included. Median disease duration and age at time of first rituximab cycle were 10 and 57 years, respectively. Median total follow-up was 55 months and median number of cycles five. 93.1% of patients were seropositive. 31.2% of patients stopped RTX, with the largest reason for discontinuing being primary inefficacy (42.1%). Comparison of Kaplan-Meier curves showed that rituximab drug survival was lower in seronegative patients and in patients who had previously failed at least one biologic DMARD (bDMARD). Cox regression analysis revealed that RTX discontinuation was associated with a greater number of previous bDMARDs. Conclusion Many patients with RA achieve good control of their disease with repeated cycles of rituximab treatment. The most common reasons for treatment discontinuation were either primary or secondary inefficacy. Patients who were seronegative and who had previously failed other bDMARDs were more at risk of drug discontinuation.

Factors Determining Retreatment Time Interval of Rituximab in Korean Patients With Rheumatoid Arthritis

“…The persistent rates of rituximab were high in our cohort owing to the high proportion of patients taking concomitant csDMARDs or corticosteroids. The treatment failure rate in this study was 18.3%, which is lower than that in other studies (19,20). However, the most common reasons for treatment failure (i.e., lack of efficacy, death, and adverse events) were similar to those in previous studies (19).…”

“…In our study, 72.4% of patients with RA continued rituximab after 5 years, indicating higher effectiveness and tolerability than previously reported in other cohorts. The rate of persistence in most previous reports ranged from 50-60% after 4 years of rituximab (19)(20)(21). The reason for this trend is unclear because there are no differences in disease activity, seropositivity, or number of prior biologic agents between our study and other studies (19,20).…”

“…The rate of persistence in most previous reports ranged from 50-60% after 4 years of rituximab (19)(20)(21). The reason for this trend is unclear because there are no differences in disease activity, seropositivity, or number of prior biologic agents between our study and other studies (19,20).…”

“…Increasing evidence shows that on-demand, rather than fixed regular retreatment, is a reasonable schedule for long-term maintenance treatment of rituximab in patients with RA (30). The time interval for the average rituximab treatment course in our patients was 16 months, which was longer than in published literature (12,20,31). In several real-life observational studies, the average response duration of rituximab ranged from 7.8 months to 13 months.…”

Long-term drug effectiveness and survival for reference rituximab in rheumatoid arthritis patients in an ordinary outpatient clinic

“…Data from registries and structured medical records used in outpatient clinics are necessary to establish the long-term efficacy and safety of the ref-RTX drug for the treatment of RA in ordinary clinical practice 4 . For ref-RTX, there is a deficiency of long-term studies exploring drug effectiveness 5 – 9 and drug survival 9 – 13 in RA patients treated in ordinary clinical practice. As inconsistent findings have been reported in the literature, there is also a need to further illuminate the clinical value of concomitant use of csDMARDs 6 , 8 , 12 , the use of ref-RTX as a first-line biologic drug and to explore predictors of the clinical outcome when the drug is used in ordinary clinical practice.…”