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Which subgroup of patients with rheumatoid arthritis benefits from switching to rituximab versus alternative anti-tumour necrosis factor (TNF) agents after previous failure of an anti-TNF agent?
|Published in||Annals of the Rheumatic Diseases. 2010, vol. 69, no. 2, p. 387-393|
|Abstract||BACKGROUND: Patients with rheumatoid arthritis (RA) with an inadequate response to TNF antagonists (aTNFs) may switch to an alternative aTNF or start treatment from a different class of drugs, such as rituximab (RTX). It remains unclear in which clinical settings these therapeutic strategies offer most benefit. OBJECTIVE: To analyse the effectiveness of RTX versus alternative aTNFs on RA disease activity in different subgroups of patients. METHODS: A prospective cohort study of patients with RA who discontinued at least one aTNF and subsequently received either RTX or an alternative aTNF, nested within the Swiss RA registry (SCQM-RA) was carried out. The primary outcome, longitudinal improvement in 28-joint count Disease Activity Score (DAS28), was analysed using multivariate regression models for longitudinal data and adjusted for potential confounders. RESULTS: Of the 318 patients with RA included; 155 received RTX and 163 received an alternative aTNF. The relative benefit of RTX varied with the type of prior aTNF failure: when the motive for switching was ineffectiveness to previous aTNFs, the longitudinal improvement in DAS28 was significantly better with RTX than with an alternative aTNF (p = 0.03; at 6 months, -1.34 (95% CI -1.54 to -1.15) vs -0.93 (95% CI -1.28 to -0.59), respectively). When the motive for switching was other causes, the longitudinal improvement in DAS28 was similar for RTX and alternative aTNFs (p = 0.40). These results were not significantly modified by the number of previous aTNF failures, the type of aTNF switches, or the presence of co-treatment with a disease-modifying antirheumatic drug. CONCLUSION: This observational study suggests that in patients with RA who have stopped a previous aTNF treatment because of ineffectiveness changing to RTX is more effective than switching to an alternative aTNF.|
|Keywords||Antibodies, Monoclonal/*therapeutic use — Antibodies, Monoclonal, Murine-Derived — Antigens, CD20/immunology — Antirheumatic Agents/*therapeutic use — Arthritis, Rheumatoid/*drug therapy — Female — Humans — Male — Middle Aged — Patient Selection — Prospective Studies — Severity of Illness Index — Treatment Failure — Treatment Outcome — Tumor Necrosis Factor-alpha/*antagonists & inhibitors|
|Research group||Mécanisme de l'inflammation articulaire (44)|
|FINCKH, Axel et al. Which subgroup of patients with rheumatoid arthritis benefits from switching to rituximab versus alternative anti-tumour necrosis factor (TNF) agents after previous failure of an anti-TNF agent?. In: Annals of the Rheumatic Diseases, 2010, vol. 69, n° 2, p. 387-393. doi: 10.1136/ard.2008.105064 https://archive-ouverte.unige.ch/unige:19810|