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Ann Rheum Dis. 2012 Nov;71(11):1861-4. doi: 10.1136/annrheumdis-2012-201324. Epub 2012 Jun 26.

Comparative effectiveness of switching to alternative tumour necrosis factor (TNF) antagonists versus switching to rituximab in patients with rheumatoid arthritis who failed previous TNF antagonists: the MIRAR Study.

Collaborators (223)

García A, Povedano J, Cejas P, Navarro F, Ariza Ariza JA, Ricca S, Bursón JS, Mediano WH, Ubeda MA, Blanca PS, Raya E, Garrido PM, Rueda A, Romero M, Fernández A, Belmonte Á, García R, Ruíz A, Venegas JJ, Salberii J, Menor R, Grandal Y, Paez-Camin M, del Mar Ruiz M, Mendoza D, Riesco M, Fernández C, Delgado C, Roselló R, Pina, Fabregas D, Alonso JC, García FJ, López MA, Silva RQ, Noriega JL, Arboleya L, Tinturé T, Poch LE, Areste JF, Vilamajó IR, Mai AJ, Font T, Alemany MP, Arana AU, Bustabad S, Ferraz I, Cantabrana A, Batista D, Hdez JA, Quevedo JC, Rúa-Figueroa Í, Calvo J, Arrecoechea E, Jimeno T, Sanmarti R, Hernández M, Moragues C, Möller I, Batina NM, Torné D, Segarra VT, Acosta A, Bonet M, Kanterewicz E, Rodriguez J, Figuls R, Padró ML, Gómez A, García JV, Sirvent E, Sanz DR, Ruiz JM, Ros S, del Blanco J, Maymó J, Lisbona M, Pérez C, Almirall M, Perez NA, Sánchez S, Olivé A, Garcia E, Salvador G, Riera E, Marsal, Rotés MI, Moreno E, Claveguera T, Valls R, Sala M, Valls M, Roselló L, Palau SO, Paredes S, Pujol J, Morlà R, Garrofí RF, Elias MJ, Arasa X, Querol AL, Elias MJ, Judez E, Garcia G, Virginia P, Vázquez J, Muñoz P, Álvarez JS, Aparicio AM, Sanz AH, Rey Rey J, Corteguera M, Martínez MM, Pantoja L, Montilla, Ruiz P, Santos JM, Vega JL, Salazar JM, Chamizo E, Aznar JJ, Garrido N, Escarcena AC, Conejo AF, González RV, Toron JG, Abad MÁ, Andrés MT, Freire M, Graña J, López MR, Hernández MÁ, Rodríguez JB, Garel JJ, Fernández MR, Domínguez LF, Domínguez AW, Martinez JC, Ouviña R, Hernández I, Barbazán C, Cabezas JÁ, Estevez JG, Mateo, Joven B, Galindo M, Morillas L, Dapica PF, Hombrados LG, Herrera P, García J, Alcalde M, Naredo E, Paz C, Carreño L, Salvat M, Monteagudo I, Crespo, Gonzalez, López FJ, Rabaneda EV, Coledaro E, Atrio S, Cobo T, Steiner M, de Abreu P, Illera O, Sánchez RM, Espartero MC, García VV, Valle MM, Jaefer JU, Zarco P, Prada, Mulero, González ML, Aragón Á, Escalera CR, Villalba FG, Ramos MM, Morales JM, Tornero C, Cuenca ES, Marras C, Lozano N, Aznar E, Sofía R, Cortina EL, Fito C, del Val N, Ibañez R, Gutierrez R, Vesga JC, Ruiz AA, Albizuri JM, García M, Galinder E, Ucar E, Gorordo M, Pacho A, Torre I, García F, Fernandez O, Torre F, Diez AR, Belzunegui J, Vela P, Jovaní, Fernández C, Belmonte M, González JA, Blasco FN, Beltran JT, Noguera JR, Minguez M, Pérez F, Muñoz P, Martínez, Alcañiz, Pérez AG, Castellano JA, Pérez A, González -Cruz I.

Author information

1
Department of Rheumatology Unit, Hospital Clinico Universitario, Santiago de Compostela, Santiago, Spain. juan.jesus.gomez-reino.carnota@sergas.es

Abstract

OBJECTIVE:

To compare the effectiveness of switching to rituximab (RTX) with switching to alternative tumour necrosis factor (TNF) antagonists in patients with rheumatoid arthritis (RA) failing on TNF antagonists.

METHODS:

A multicentre prospective 3-year observational study was performed in patients with RA treated with RTX or an alternative TNF antagonist. The baseline 28-joint disease activity score (DAS28) and Health Assessment Questionnaire (HAQ) score were compared with 6, 9 and 12 month values, adjusting for propensity score quintiles. Propensity scores were estimated for each patient using logistic regression with treatment as the dependent variable and baseline prior number of TNFs >1, years from diagnosis >5, extra-articular manifestations, previous toxicity, use of ≥2 disease-modifying antirheumatic drugs, age and sex as independent variables.

RESULTS:

1124 patients were treated with either RTX (n=591, 52.6%) or alternative TNF antagonists (n=533, 47.4%). RTX-treated patients had longer disease duration (p=0.0001), larger numbers of previous TNF antagonists (p<0.0001) and tender and swollen joints (p<0.0001). There was no significant difference in the reduction in DAS28 at 6, 9 and 12 months between RTX-treated patients and those treated with TNF antagonists. However, the reduction in DAS28 was significantly different between RTX-treated patients and adalimumab/infliximab-treated patients (p=0.001 and p=0.05, respectively). There was a marginally significant difference at any time period in the proportion of patients achieving an improvement in the HAQ score of >0.22 (p=0.06).

CONCLUSIONS:

Optimal treatment for patients with RA failing on treatment with TNF antagonists may include RTX. This study suggests that the improvement in DAS28 is larger in patients treated with RTX than in those treated with monoclonal anti-TNF agents.

PMID:
22736086
DOI:
10.1136/annrheumdis-2012-201324
[Indexed for MEDLINE]

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