Clinical Outcomes With Rituximab Retreatment in Rheumatoid Arthritis

Rituximab significantly reduces mean DAS28 scores in patients with rheumatoid arthritis after retreatment cycles.

Patients with rheumatoid arthritis (RA) taking rituximab (RTX) had significantly lower 28-joint Disease Activity Scores (DAS28) at subsequent retreatment cycles, with patients undergoing treatment at a fixed interval showing better results compared with patients undergoing on-flare retreatment, according to recent results published in The Journal of Rheumatology.

The study was split into 2 parts. Katerina Chatzidionysiou, MD, PhD, from the Karolinska Institute department of medicine and unit for clinical therapy research, inflammatory diseases in Solna, Sweden, and colleagues measured the DAS28 in 1530 patients with RA from the European Collaborative Registries for the Evaluation of RTX in Rheumatoid Arthritis (CERERRA) who received RTX for at least 4 cycles.

In a second analysis, the researchers measured DAS28 at the beginning of subsequent retreatment cycles in 184 patients who received RTX at a fixed interval and 616 patients who were retreated on flare.

“Repeated retreatment with RTX can lead to further clinical improvement after the first course of RTX,” the investigators wrote in their study. “A fixed retreatment strategy with RTX in RA seems to be more effective than the strategy of retreating on flare.”

High Yield Data Summary

  • Results from a large, observational, multicenter study suggest that repeated treatment cycles with rituximab decrease RA disease activity, as measured by DAS28 scores.

In the first analysis, patients had a DAS28 of 5.5 in the first treatment cycle, 4.3 in the second cycle, 3.8 in the third cycle, and 3.5 in the fourth cycle (P <.0001).

In the second analysis, patients in the fixed-interval group had an estimated marginal mean DAS28 of 3.8 (95% CI, 3.6-4.1) compared with an on-flare group DAS28 of 4.6 (95% CI, 4.5- 4.7; P <.0001).

In the fixed-interval group, the second retreatment had an estimated marginal mean of −3.7 (95% CI, 3.3-4.0) compared with a DAS28 of 4.6 (95% CI, 4.4-4.8; P <.0001) in the on-flare group.

“The results of the mixed-model regression analysis suggested that a fixed retreatment approach, before a flare occurs, might lead to more favorable results,” the researchers wrote. “[D]uring the first months after the first and second retreatment, patients retreated on a fixed interval constantly have lower DAS28 than those retreated on flare, and this is clinically relevant and closer to the treat-to-target approach.”

Summary & Clinical Applicability

“The results of our large, observational, international, collaborative study support the effect of repeated treatment cycles with RTX on RA disease activity. Disease activity in patients who continue with RTX is likely to further decrease with repeated RTX treatment cycles,” Dr Chatzidionysiou and colleagues wrote.

“This is a clinically relevant and important observation, which partly confirms [results from] some previous clinical trials and observational studies.”

Study Limitations

  • Researchers noted collection of more systematic high-quality safety data, safety of repeated treatment, and analysis of cost effectiveness was needed

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Chatzidionysiou K, Lie E, Lukina G, et al. Rituximab retreatment in rheumatoid arthritis in a real-life cohort: data from the CERERRA Collaboration [published online January 15, 2017]. J Rheumatol. doi: 10.3899/jrheum.160460

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