Real‐world effectiveness and safety of rituximab in the treatment of rheumatoid arthritis: A single‐center experience in Taiwan

Abstract

Aim To assess the real‐world effectiveness and safety of rituximab (RTX) at 24 months in patients with established rheumatoid arthritis (RA) and to identify predictors of low disease activity/remission and a good European League Against Rheumatism (EULAR) response. Methods Seventy RTX‐treated RA patients were enrolled. Predictors for low disease activity/remission and a good EULAR response at 24 months were identified by multivariate analyses. Results At 24 months, the mean Disease Activity Score of 28 joints—erythrocyte sedimentation rate (DAS28‐ESR) decreased from 6.88 ± 0.85 at baseline to 3.47 ± 0.85. Twenty‐nine patients (41.4%) reached low disease activity/remission, while all patients had a moderate/good EULAR response. After adjustment by multivariate analyses, we found concomitant methotrexate at a dosage >10 mg/week (odds ratio [OR] 5.17; 95% CI 1.34‐19.93; P = 0.017) predicted low disease activity/remission, and baseline DAS28 ≤6.5 (OR 4.97; 95% CI 1.22‐20.30; P = 0.026) predicted good EULAR response at 24 months. The most common adverse events were infusion‐related (5.7%), and there was no incidence of malignancy or mortality during the treatment. Conclusions RTX was effective and safe in real‐life management of RA patients with high disease activity. Patients taking concomitant methotrexate and with lower baseline DAS28‐ESR were more likely to benefit from RTX.

Pemphigus: Current and Future Therapeutic Strategies

“…RTX is a chimeric type I monoclonal anti CD20 antibody, consisting of a human Fc portion and a murine variable region which serve as CD20 binding site (119). RTX was first licensed for use in B-cell malignancies (120), however, it is currently used in several autoimmune disorders, and has been recently licensed as first-line treatment in pemphigus (121–124). RTX target, CD20, is a transmembrane receptor, that is expressed across various developmental stages of the B-cell, from the pre-B cell to the mature; while, early precursor pro-B cells and antibody-producing plasma cells do not express it (125).…”

Predictors of remission in rheumatoid arthritis patients treated with biologics: a systematic review and meta-analysis

“…A total of 16,934 patients were included in the 21 studies. Remission criteria was defined as disease activity score (DAS28) of less than or equal to 2.6 [ 11 – 23 , 26 , 28 , 30 ]. Other studies used the simplified disease activity index (SDAI) score of less than or equal to 3.3 to assess for remission [ 24 , 25 , 27 , 29 , 31 ].…”

“…2 , respectively. We performed meta-analyses for six sociodemographic-related factors including age older than 55 year old (fifteen studies [ 11 , 12 , 14 , 15 , 18 , 20 – 23 , 25 , 28 – 31 ]), female gender (sixteen studies [ 11 , 14 – 17 , 19 – 25 , 27 , 30 , 31 ]), obesity defined as BMI ≥ 30 kg/m 2 (four studies [ 16 , 21 , 27 , 31 ]), smoking status defined as current or ex-smoker (seven studies [ 11 , 14 – 16 , 18 , 21 ]), poor baseline functional status defined as Health Assessment Questionnaire (HAQ) of more than two (nine studies [ 11 , 14 , 16 , 20 , 21 , 24 , 25 , 27 ]), and presence of comorbidities (three studies [ 11 , 15 ]). Our analysis showed that old age (OR 0.98 (0.97, 0.99), P < 0.00001), female gender (OR 0.66 (0.56, 0.77), P < 0.00001), BMI > 30 (OR 0.95 (0.91, 0.99), P 0.02), smoking history (OR 0.86 (0.75, 0.99), P 0.04), and baseline HAQ > 2 (OR 0.62 (0.48, 1.27), P < 0.00001) are significantly associated with low rate of remission.…”

“…All the included studies were published between April 2006 and August 2021. Based on country of origin, six studies originated from Japan [22,[25][26][27][28][29], two studies originated from the USA [14,24], two studies originated from Italy [15,20], two studies originated from United Kingdom [11,21], two studies from France [18,19], one study from Canada [16], one study from Greece [17], one study from Germany [12], one study from Ireland [30], one study from Australia [31], and one study from Taiwan [23]. Regarding the study design, all the included studies were either retrospective or prospective cohort except of Listing et al [12] that was a randomized control trial.…”

“…Some studies showed that old age, female gender, smoking history, obesity, presence of comorbidities, increased disease activity at the time of diagnosis, increased disease duration, and poor functional status at baseline have been associated with a lower response rate to biologics [4-6, 8, 9, 14, 15, 17]. While other studies showed no significant association between age, gender, and remission rate [15,18,23]. Patients with elevated ESR at the time of diagnosis have also shown poor response to biologics in some studies [9,14], but there was no significant association in other studies [8,17].…”