Rituximab may be better second-line RA therapy when anti-TNF fails

Switching patients with rheumatoid arthritis (RA) to rituximab (Rituxan, Genentech) may be more effective than switching them to a second alternative anti-tumor necrosis factor (anti-TNF) after a first anti-TNF therapy has failed, according to a study published online in Arthritis Care & Research.

Anti-TNF therapies are routinely used for managing patients with RA who have failed traditional non-biologic disease modifying anti-rheumatic drugs, according to Moetaza Soliman, a PhD student from the School of Pharmacy and Pharmaceutical Sciences, University of Manchester, United Kingdom, and colleagues.

However, about 30% of patients discontinue the treatment within 1 year due to inefficacy or side effects. In these cases, patients can be switched to an alternative anti-TNF or rituximab. Both have been indicated as effective treatments in clinical trials, but no trials have directly compared the 2 methods of therapy.

To compare the effectiveness of rituximab or a second anti-TNF therapy in routine clinical practice, the research team used data from the British Society for Rheumatology Biologics Register, a national prospective observational study investigating the short- and long-term safety of biologic therapy for the treatment of RA patients in the United Kingdom.

They analyzed patient treatment response 6 months after switching either to rituximab or to an alternative anti-TNF inhibitor, assessing 1,328 patients using European League Against Rheumatism (EULAR) criteria and 937 patients by improvement in Health Assessment Questionnaire (HAQ) score.

Six months after switching, the researchers found that patients taking rituximab were significantly more likely to achieve EULAR response (54.8%) than those who switched to a second anti-TNF (47.3%). Patients taking rituximab also were significantly more likely to achieve improvements in HAQ score (38.4%) compared with those who switched to a second anti-TNF (29.6%).

The authors state that the results suggest that patients who fail a first anti-TNF may benefit from rituximab as a second-line therapy rather than a second anti-TNF.

“Future analysis that considers the response in multiple anti-TNF switchers, or specifically looking at the reason for the switching is likely to be of interest,” the authors concluded.