Rituximab Use in Everyday Clinical Practice
Rituximab Use in Everyday Clinical Practice
Objectives: This study assessed the utility of rituximab for the therapy of RA in a non-academic environment in a group of cases where anti-TNF was either not available or relatively contraindicated.
Methods: Thirty-nine patients with active RA who had failed at least one DMARD received two rituximab infusions 2 weeks apart. Seventeen patients received two 1000 mg doses, and 22 received the 500 mg regimen. The 28-joint disease activity index (DAS28) and European League against Rheumatism (EULAR) response criteria were recorded at baseline, 3, 6, 9 and 12 months. RF and ANA were recorded at baseline and at 6 and 12 months.
Results: There was a significant improvement in the DAS28 at all time points, and EULAR response was observed in 29 of 33 patients (87.9%) at 3 months, 25 of 33 patients (75.8%) at 6 months, 22 of 29 patients (75.9%) at 9 months and 23 of 30 patients (76.7) at 12 months. Improvement was also noted in CRP, and both RF and ANA were generally reduced after treatment. Patients who were on the higher regimen of two 1000 mg doses appeared to respond slightly better compared with the lower dose regimen.
Conclusions: Rituximab is well tolerated in everyday clinical practice and may represent a good short-term treatment option where anti-TNF therapy is either unavailable or relatively contraindicated.
RA is the commonest inflammatory arthropathy and affects nearly half a million patients in the UK. The current first-line treatment utilizes DMARDs that often have suboptimal responses. The introduction of TNF inhibitors offered a new option for patients with DMARD-resistant disease. Upon the licensing of anti-TNF agents, the health care service structure of the UK meant that literally hundreds of thousands of patients were potentially suitable for therapy. Given the costs of therapy, the prescribing of anti-TNF agents for inflammatory arthritis has been patchy, which has restricted the availability of anti-TNF agents in some regions.
Rituximab in combination with MTX was licensed in the UK in 2006 for the treatment of adult patients with severe active RA who have had an inadequate response to, or been intolerant to conventional DMARDs and one or more TNF inhibitors. However, the early clinical studies that demonstrated the efficacy of rituximab in RA were carried out in patients who had not previously received TNF inhibitors. Recognizing that rituximab was going to be licensed for RA and due to the inability to obtain anti-TNF therapy, we have used rituximab as a first-line biological agent between 2004 and early 2007. In this article, we report our experience for the treatment of RA in daily clinical practice in a non-academic centre.
Objectives: This study assessed the utility of rituximab for the therapy of RA in a non-academic environment in a group of cases where anti-TNF was either not available or relatively contraindicated.
Methods: Thirty-nine patients with active RA who had failed at least one DMARD received two rituximab infusions 2 weeks apart. Seventeen patients received two 1000 mg doses, and 22 received the 500 mg regimen. The 28-joint disease activity index (DAS28) and European League against Rheumatism (EULAR) response criteria were recorded at baseline, 3, 6, 9 and 12 months. RF and ANA were recorded at baseline and at 6 and 12 months.
Results: There was a significant improvement in the DAS28 at all time points, and EULAR response was observed in 29 of 33 patients (87.9%) at 3 months, 25 of 33 patients (75.8%) at 6 months, 22 of 29 patients (75.9%) at 9 months and 23 of 30 patients (76.7) at 12 months. Improvement was also noted in CRP, and both RF and ANA were generally reduced after treatment. Patients who were on the higher regimen of two 1000 mg doses appeared to respond slightly better compared with the lower dose regimen.
Conclusions: Rituximab is well tolerated in everyday clinical practice and may represent a good short-term treatment option where anti-TNF therapy is either unavailable or relatively contraindicated.
RA is the commonest inflammatory arthropathy and affects nearly half a million patients in the UK. The current first-line treatment utilizes DMARDs that often have suboptimal responses. The introduction of TNF inhibitors offered a new option for patients with DMARD-resistant disease. Upon the licensing of anti-TNF agents, the health care service structure of the UK meant that literally hundreds of thousands of patients were potentially suitable for therapy. Given the costs of therapy, the prescribing of anti-TNF agents for inflammatory arthritis has been patchy, which has restricted the availability of anti-TNF agents in some regions.
Rituximab in combination with MTX was licensed in the UK in 2006 for the treatment of adult patients with severe active RA who have had an inadequate response to, or been intolerant to conventional DMARDs and one or more TNF inhibitors. However, the early clinical studies that demonstrated the efficacy of rituximab in RA were carried out in patients who had not previously received TNF inhibitors. Recognizing that rituximab was going to be licensed for RA and due to the inability to obtain anti-TNF therapy, we have used rituximab as a first-line biological agent between 2004 and early 2007. In this article, we report our experience for the treatment of RA in daily clinical practice in a non-academic centre.
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