Second Line of Defense Against RA

Rituximab for rheumatoid arthritis better choice when first round of TNF inhibitors fail

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) People with rheumatoid arthritis are often treated with anti-TNF drugs. When these drugs fail, patients may need to switch to a different drug. But which drug should be the second line of defense?

Rheumatoid arthritis patients may benefit more from switching to Rituxan (rituximab) than switching to a second anti-TNF drug after the first anti-TNF drug failed.

"Work with your doctor to find the best arthritis drug."

Rituximab is part of a class of drugs called biologic antineoplastic agents. The drug treats rheumatoid arthritis by killing blood cells that may cause the immune system to mistakenly attack healthy joints and tissues. Both rituximab and anti-TNF drugs are used to treat rheumatoid arthritis in patients who have already been treated with other anti-TNF drugs.

Darren M. Ashcroft, PhD, of the University of Manchester, and colleagues wanted to see whether rituximab or a second anti-TNF drug worked better for rheumatoid arthritis patients who did not respond well to a first anti-TNF drug.

In their study, Dr. Ashcroft and colleagues measured patients' responses to drugs using the European League Against Rheumatism (EULAR) criteria and the Health Assessment Questionnaire (HAQ).

To give patients a EULAR score, doctors counted the number of joints affected by arthritis and measured levels of certain substances in the blood that are involved in rheumatoid arthritis.

In the HAQ, patients are asked a variety of questions made to measure disability.

Six months after switching to a new drug, 54.8 percent of patients who switched to rituximab were EULAR responders, meaning they responded to the drug. In comparison, 47.3 percent of patients who switched to a second anti-TNF drug were EULAR responders.

Patients who switched to rituximab also had more improved disability than those who switched to another anti-TNF drug. A total of 38.4 percent of those who switched to rituximab had a significant improvement in HAQ score, compared to 29.6 percent of those who switched to a second anti-TNF drug.

Patients who switched to rituximab were 1.31 times more likely to reach EULAR response compared to those who switched to another anti-TNF drug.

Rituximab patients were also 1.49 times more likely to improve their HAQ score.

According to the authors, "The results suggest that switched to rituximab may be of more benefit than switching to an alternative anti-TNF therapy after failing the first anti-TNF therapy in rheumatoid arthritis patients."

A total of 1,328 patients were included in the measures of EULAR response, while 937 were involved in the analysis of HAQ scores.

The research was funded by the Egyptian government.

The researchers also received support from the British Society for Rheumatology, which receives restricted funding from a number of UK pharmaceutical companies, including Abbott Laboratories and Roche.

The study was published July 27 in Arthritis Care & Research.

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Review Date: 
August 8, 2012
Last Updated:
May 15, 2013