Rituximab or a Second Anti-Tumor Necrosis Factor Therapy for Rheumatoid Arthritis Patients Who Have Failed Their First Anti-Tumor Necrosis Factor Therapy? Comparative Analysis From the British Society for Rheumatology Biologics Register

University of Manchester, UK.
Arthritis care & research 07/2012; 64(8):1108-15. DOI: 10.1002/acr.21663
Source: PubMed


To compare the effectiveness of rituximab (RTX) or a second anti-tumor necrosis factor (anti-TNF) therapy in rheumatoid arthritis (RA) patients who had failed their first anti-TNF and switched to either RTX or a second anti-TNF, in routine clinical practice.
RA patients were registered with the British Society for Rheumatology Biologics Register. Response to treatment 6 months after switching was assessed using European League Against Rheumatism (EULAR) criteria and improvements in a Health Assessment Questionnaire (HAQ) score (0.22 unit or more). Regression analyses were used to compare EULAR response and improvement in HAQ score between the 2 groups, adjusting for propensity scores.
In total, 1,328 patients were included in the analysis of EULAR response, and 937 patients were included in the analysis of HAQ scores. Six months after switching, 54.8% of patients who switched to RTX were EULAR responders compared to 47.3% of those who switched to a second anti-TNF. A total of 38.4% of RTX patients achieved a clinically important improvement in HAQ score compared to 29.6% in anti-TNF patients. After adjustment using propensity scores, patients who switched to RTX were significantly more likely to achieve EULAR response (odds ratio [OR] 1.31; 95% confidence interval [95% CI] 1.02, 1.69) compared to those who switched to an alternative anti-TNF. RTX patients were also significantly more likely to achieve improvements in HAQ score (OR 1.49; 95% CI 1.07, 2.08).
The results suggest that switching to RTX may be of more benefit than switching to an alternative anti-TNF therapy after failing the first anti-TNF therapy in RA patients.

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    • "Only 12% of our patients had disease duration of less than one year reflecting the importance of early referral and early disease control. The first choice of biological therapy was ADA and the second choice biological therapy after the failure of the first was RTX, which is consistent with the ACR/EULAR recommendations [14] [15] [23]. The choice of biological agent was strongly associated with the preferences of the individual doctors, the year of treatment initiation, and availability of the drug in the hospital. "

    Full-text · Article · Sep 2015 · Open Journal of Rheumatology and Autoimmune Diseases
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    • "The MIRAR trial focused on an important issue directly comparing the use of an alternative anti-TNF versus rituximab after a first anti-TNF failure, with both treatments producing comparable benefits.38 Conversely, several observational studies have suggested that rituximab may be more effective than a second anti-TNF in some subgroups,39 although clinical trials confirming this are lacking. "
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