PARIS — Rituximab may be a better choice than another tumor necrosis factor inhibitor for patients with rheumatoid arthritis whose disease remains active despite anti-TNF therapy, according to a study of more than 300 patients.
“We and others have shown that switching to a different class of biological agents may be more effective than going to a second or third anti-TNF agent,” Dr. Axel Finckh said at the annual European Congress of Rheumatology.
Patients interrupt anti-TNF therapy for various reasons, including lack of efficacy, adverse events, convenience, and preferences. To determine if the reason for discontinuation could influence the efficacy of subsequent therapy, a prospective longitudinal observational study was undertaken that included all rheumatoid arthritis (RA) patients in a Swiss national cohort who failed a course of TNF inhibitor therapy, said Dr. Finckh of Geneva University Hospital.
The primary outcome was the evolution in disease activity score 28 (DAS28) in the first year after switching, analyzed by multivariate regression models.
Among the 325 adult patients included in the study, 175 switched to another anti-TNF drug while 150 switched to the B-cell-depleting agent rituximab, according to Dr. Finckh.
Overall, the reason for discontinuation of the previous regimen was lack of efficacy in 65%. Of those, 28% were primary failures who experienced no response to therapy and 72% were secondary failures who initially responded but then lost the response.
The remaining 35% of patients switched because of adverse events, he said.
At the time of switching, there were no significant differences between the anti-TNF group and the rituximab group in terms of patient age, gender, disease duration, or concomitant steroid or conventional disease-modifying anti-rheumatic drug use.
Patients who switched to another anti-TNF drug had lower baseline DAS scores, however, at a mean of 4.0, compared with a mean of 4.97 in the rituximab group. After adjustment for this and other confounders, the evolution of DAS28 was overall more favorable for the rituximab group, he said.
When the motive for switching was lack of efficacy of the original TNF inhibitor, the evolution of DAS28 was significantly better for rituximab, with scores decreasing by 1.55 at 6 months, compared with a decrease of 1.03 for the anti-TNF group.
However, when the reason for switching was an adverse event, the evolution of DAS28 was similar in the two groups, with rituximab patients having a decrease in scores of 0.86 and the anti-TNF group decreasing by 0.77.
There was no effect modification by other variables, including primary versus secondary failure or concomitant DMARD use.
“This observational study suggests that patients who demonstrate therapeutic resistance to anti-TNF therapy may benefit from switching to rituximab,” Dr. Finckh concluded.
The study was partially supported by Roche.
I believe what the article is saying is that you are using a TNF inhibitor and your RA is still active, instead of swithing to another TNF inhibitor it might be a better idea to try a B-cell depletor, like Rituxan.