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Which subgroup of rheumatoid arthritis patients benefits from switching to rituximab versus alternative anti-TNF agents after previous failure to anti-TNF agent?


Finckh, A; Ciurea, A; Brulhart, L; Möller, B; Walker, U A; Courvoisier, D; Kyburz, D; Dudler, J; Gabay, C (2010). Which subgroup of rheumatoid arthritis patients benefits from switching to rituximab versus alternative anti-TNF agents after previous failure to anti-TNF agent? Annals of the Rheumatic Diseases, 69(2):387-393.

Abstract

BACKGROUND: Rheumatoid arthritis (RA) patients with an inadequate response to TNF inhibitors (aTNF) may switch to an alternative aTNF or start a treatment from a different class, such as rituximab (RTX). It remains unclear in which clinical settings these therapeutic strategies offer most benefit. OBJECTIVE: To analyze the effectiveness of RTX versus alternative aTNFs on RA disease activity in different subgroups of patients. METHODS: This is a prospective cohort study of RA patients who discontinued at least one aTNF and subsequently received either RTX or an alternative aTNF, nested within the Swiss RA registry (SCQM-RA). The primary outcome, longitudinal improvement in DAS28, was analysed using multivariate regression models for longitudinal data and adjusted for potential confounders. RESULTS: Of the 318 RA patients 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 alternative aTNF (p = 0.03; at 6 months, -1.34 (95% CI: -1.54; -1.15) versus -0.93 (95% CI: -1.28; -0.59) respectively). When the motive for switching was other causes, the longitudinal improvement in DAS28 was similar between 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 DMARD co-therapy. CONCLUSION: This observational study suggests that RTX is more effective than switching to an alternative aTNF in RA patients who stopped a previous aTNF treatment because of ineffectiveness.

BACKGROUND: Rheumatoid arthritis (RA) patients with an inadequate response to TNF inhibitors (aTNF) may switch to an alternative aTNF or start a treatment from a different class, such as rituximab (RTX). It remains unclear in which clinical settings these therapeutic strategies offer most benefit. OBJECTIVE: To analyze the effectiveness of RTX versus alternative aTNFs on RA disease activity in different subgroups of patients. METHODS: This is a prospective cohort study of RA patients who discontinued at least one aTNF and subsequently received either RTX or an alternative aTNF, nested within the Swiss RA registry (SCQM-RA). The primary outcome, longitudinal improvement in DAS28, was analysed using multivariate regression models for longitudinal data and adjusted for potential confounders. RESULTS: Of the 318 RA patients 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 alternative aTNF (p = 0.03; at 6 months, -1.34 (95% CI: -1.54; -1.15) versus -0.93 (95% CI: -1.28; -0.59) respectively). When the motive for switching was other causes, the longitudinal improvement in DAS28 was similar between 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 DMARD co-therapy. CONCLUSION: This observational study suggests that RTX is more effective than switching to an alternative aTNF in RA patients who stopped a previous aTNF treatment because of ineffectiveness.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Rheumatology Clinic and Institute of Physical Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:February 2010
Deposited On:26 Jan 2010 11:40
Last Modified:05 Apr 2016 13:47
Publisher:BMJ Publishing Group
ISSN:0003-4967
Publisher DOI:https://doi.org/10.1136/ard.2008.105064
PubMed ID:19416802
Permanent URL: https://doi.org/10.5167/uzh-28007

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