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J Rheumatol. 2017 Feb;44(2):162-169. doi: 10.3899/jrheum.160460. Epub 2017 Jan 15.

Rituximab Retreatment in Rheumatoid Arthritis in a Real-life Cohort: Data from the CERERRA Collaboration.

Author information

1
From the Karolinska Institute, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Stockholm, Sweden; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; ARBITER, Institute of Rheumatology, Moscow, Russia; DANBIO, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Institute of Rheumatology, Prague, Czech Republic; Swiss Clinical Quality Management (SCQM) Registry, University Hospital of Geneva, Geneva; SCQM Foundation, Zurich, Switzerland; National Register for Biologic Treatment in Finland (ROB-FIN), Helsinki University Central Hospital, Helsinki, Finland; Reuma.pt Registry, Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; BioRx.si University Medical Centre, Ljubljana, Ljubljana, Slovenia; Rheumatology Department, Hospital Clinic of Barcelona, Barcelona; Hospital Clinico Universidad De Santiago, Santiago, Spain; Cantacuzino Hospital, Bucharest, Romania. aikaterini.chatzidionysiou@karolinska.se.
2
K. Chatzidionysiou, MD, PhD, Karolinska Institute, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID); E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; G. Lukina, MD, PhD, ARBITER, Institute of Rheumatology; M.L. Hetland, MD, PhD, Professor, DANBIO, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital; K. Pavelka, MD, PhD, Professor, Institute of Rheumatology; C. Gabay, MD, PhD, Professor, SCQM Registry, University Hospital of Geneva; A. Scherer, PhD, SCQM Foundation; D. Nordström, MD, PhD, Professor, ROB-FIN, Helsinki University Central Hospital; H. Canhao, MD, PhD, Professor, Reuma.pt Registry, Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa; M.J. Santos, MD, PhD, Reuma.pt Registry, Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa; M. Tomsic, MD, PhD, Professor, BioRx.si University Medical Centre; Z. Rotar, MD, BioRx.si University Medical Centre; M.V. Hernández, MD, PhD, Rheumatology Department, Hospital Clinic of Barcelona; J. Gomez-Reino, MD, PhD, Professor, Hospital Clinico Universidad De Santiago; I. Ancuta, MD, Cantacuzino Hospital; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; R. van Vollenhoven, MD, PhD, Professor, Karolinska Institute, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID). aikaterini.chatzidionysiou@karolinska.se.
3
From the Karolinska Institute, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Stockholm, Sweden; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; ARBITER, Institute of Rheumatology, Moscow, Russia; DANBIO, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Institute of Rheumatology, Prague, Czech Republic; Swiss Clinical Quality Management (SCQM) Registry, University Hospital of Geneva, Geneva; SCQM Foundation, Zurich, Switzerland; National Register for Biologic Treatment in Finland (ROB-FIN), Helsinki University Central Hospital, Helsinki, Finland; Reuma.pt Registry, Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; BioRx.si University Medical Centre, Ljubljana, Ljubljana, Slovenia; Rheumatology Department, Hospital Clinic of Barcelona, Barcelona; Hospital Clinico Universidad De Santiago, Santiago, Spain; Cantacuzino Hospital, Bucharest, Romania.
4
K. Chatzidionysiou, MD, PhD, Karolinska Institute, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID); E. Lie, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; G. Lukina, MD, PhD, ARBITER, Institute of Rheumatology; M.L. Hetland, MD, PhD, Professor, DANBIO, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital; K. Pavelka, MD, PhD, Professor, Institute of Rheumatology; C. Gabay, MD, PhD, Professor, SCQM Registry, University Hospital of Geneva; A. Scherer, PhD, SCQM Foundation; D. Nordström, MD, PhD, Professor, ROB-FIN, Helsinki University Central Hospital; H. Canhao, MD, PhD, Professor, Reuma.pt Registry, Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa; M.J. Santos, MD, PhD, Reuma.pt Registry, Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa; M. Tomsic, MD, PhD, Professor, BioRx.si University Medical Centre; Z. Rotar, MD, BioRx.si University Medical Centre; M.V. Hernández, MD, PhD, Rheumatology Department, Hospital Clinic of Barcelona; J. Gomez-Reino, MD, PhD, Professor, Hospital Clinico Universidad De Santiago; I. Ancuta, MD, Cantacuzino Hospital; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; R. van Vollenhoven, MD, PhD, Professor, Karolinska Institute, Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID).

Abstract

OBJECTIVE:

Several aspects of rituximab (RTX) retreatment in rheumatoid arthritis (RA) need to be further elucidated. The aim of this study was to describe the effect of repeated courses of RTX on disease activity and to compare 2 retreatment strategies, fixed-interval versus on-flare retreatment, in a large international, observational, collaborative study.

METHODS:

In the first analysis, patients with RA who received at least 4 cycles with RTX were included. In the second analysis, patients who received at least 1 RTX retreatment and for whom information about the strategy for retreatment was available were identified. Two retreatment strategies (fixed-interval vs on-flare) were compared by fitting-adjusted, mixed-effects models of 28-joint Disease Activity Score (DAS28) over time for first and second retreatment.

RESULTS:

A total of 1530 patients met the eligibility criteria for the first analysis. Significant reductions of mean DAS28 between the starts of subsequent treatment cycles were observed (at start of first treatment cycle: 5.5; second: 4.3; third: 3.8; and fourth: 3.5), suggesting improved response after each additional cycle (p < 0.0001 for all pairwise comparisons). A total of 800 patients qualified for the second analysis: 616 were retreated on flare and 184 at fixed interval. For the first retreatment, the fixed-interval retreatment group yielded significantly better results than the on-flare group (estimated marginal mean DAS28 = 3.8, 95% CI 3.6-4.1 vs 4.6, 95% CI 4.5-4.7, p < 0.0001). Similar results were found for the second retreatment.

CONCLUSION:

Repeated treatment with RTX leads to further clinical improvement after the first course of RTX. A fixed-interval retreatment strategy seems to be more effective than on-flare retreatment.

KEYWORDS:

RETREATMENT; RHEUMATOID ARTHRITIS; RITUXIMAB

PMID:
28089978
DOI:
10.3899/jrheum.160460
[Indexed for MEDLINE]

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