A single infusion of 1000 mg rituximab delays the development of arthritis in patients at risk of developing rheumatoid arthritis (RA), according to study results published in the Annals of the Rheumatic Diseases.

The results of this study support the theory that targeted interventions before the development of signs and symptoms of arthritis may better control RA disease progression compared with interventions initiated after clinical onset.

The study included participants without arthritis who were positive for both anti-citrullinated peptide antibodies and rheumatoid factor (n=81). Participants were randomly assigned to receive a single infusion of 1000 mg rituximab or placebo.

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After a mean of 29.0 months of follow-up 37% of participants (n=30) developed arthritis.

There was a 40% observed risk in the placebo group; this was decreased by 55% (HR, 0.45; 95% CI, 0.154-1.322) in the rituximab-treated group at 12 months.

The results indicated that rituximab treatment caused a 12-month delay in arthritis development compared with placebo treatment at the point at which 25% of participants had developed arthritis (P <.0001).

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The researchers found that erythrocyte sedimentation rate and the presence of anti-citrullinated α-enolase peptide 1 at baseline were both significantly associated with arthritis development.

“The results presented here are clearly consistent with the critical role of B cells in the pathogenesis of RA during the earliest stages of the disease and support future studies aimed at secondary prevention of RA, including by the use of targeted treatments,” the researchers wrote.

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Gerlag DM, Safy M, Maijer KI, et al. Effects of B-cell directed therapy on the preclinical stage of rheumatoid arthritis: the PRAIRI study [published online December 1, 2018]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-212763