RT Journal Article
SR Electronic
T1 Rituximab Retreatment in Rheumatoid Arthritis in a Real-life Cohort: Data from the CERERRA Collaboration
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.160460
DO 10.3899/jrheum.160460
A1 Katerina Chatzidionysiou
A1 Elisabeth Lie
A1 Galina Lukina
A1 Merete L.  Hetland
A1 Ellen-Margrethe Hauge
A1 Karel Pavelka
A1 Cem Gabay
A1 Almut Scherer
A1 Dan Nordström
A1 Helena Canhao
A1 Maria José  Santos
A1 Matija Tomsic
A1 Ziga Rotar
A1 M. Victoria  Hernández
A1 Juan Gomez-Reino
A1 Ioan Ancuta
A1 Tore K.  Kvien
A1 Ronald van Vollenhoven
YR 2017
UL http://www.jrheum.org/content/early/2017/01/05/jrheum.160460.abstract
AB 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.