Safety of biological therapies following rituximab treatment in rheumatoid arthritis patients

Genovese, Mark C.; Breedveld, Ferdinand C.; Emery, Paul; Cohen, Stanley; Keystone, Edward; Matteson, Eric L.; Baptiste, Yvette; Chai, Akiko; Burke, Laura; Reiss, William; Sweetser, Marianne T.; Shaw, Tim

doi:10.1136/ard.2008.101675

Cited by 77 publications

(45 citation statements)

References 28 publications

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“…Studies have shown significant reductions in immunoglobulin levels and possibly selective suppression of autoantibodies after treatment. A single study has reported on a series of patients given a second biological agent after rituximab without obvious added toxicity 104. Long-term toxicity remains a matter for careful registry follow-up, although early indications are encouraging.…”

Section: Biological Therapymentioning

confidence: 99%

State-of-the-art: rheumatoid arthritis

McInnes

O'Dell

2010

Annals of the Rheumatic Diseases

265

176

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The understanding of the pathogenesis and optimal therapeutics for rheumatoid arthritis (RA) has advanced remarkably over the last decade. This review highlights these key advances, particularly the outcomes of genome-wide scans which have provided an increasingly robust appraisal of the complex genetics that underpin RA. Such observations are placed in pathogenetic context, particularly concerning the breach of tolerance that presages synovitis and the mechanisms that subserve chronicity. The key therapeutic strategies and treatment agents, both conventional and biological, now available to effectively manage the disease are described. Throughout the review, emphasis is placed on unanswered questions and challenges in this exciting field.

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Section: Biological Therapymentioning

confidence: 99%

State-of-the-art: rheumatoid arthritis

McInnes

O'Dell

2010

Annals of the Rheumatic Diseases

265

176

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“…Switching from rituximab to a TNF inhibitor has been associated with a numerically, but not statistically, significant increase in serious infections in an early study;79 a subsequent report providing further follow-up of the same cohort did not suggest a major increase in infections under these circumstances 80. In this latter report TNF inhibitors were usually initiated at least 4 months after rituximab (when insufficient treatment response would be judged).…”

Section: Recommendationsmentioning

confidence: 86%

Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

Buch

Smolen

Betteridge

et al. 2011

Annals of the Rheumatic Diseases

406

304

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BackgroundSince initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab in the treatment of RA.MethodsPreparation of this new document involved many international experts experienced in the treatment of RA. Following a meeting to agree upon the core agenda, a systematic literature review was undertaken to identify all relevant data. Data were then interrogated by a drafting committee, with subsequent review and discussion by a wider expert committee leading to the formulation of an updated consensus statement. These committees also included patients with RA.ResultsThe new statement covers wide-ranging issues including the use of rituximab in earlier RA and impact on structural progression, and aspects particularly pertinent to rituximab such as co-medication, optimal dosage regimens, repeat treatment cycles and how to manage non-response. Biological therapy following rituximab usage is also addressed, and safety concerns including appropriate screening for hepatitis, immunoglobulin levels and infection risk. This consensus statement will support clinicians and inform patients when using B-cell depletion in the management of RA, providing up-to-date information and highlighting areas for further research.ConclusionNew therapeutic strategies and treatment options for RA, a chronic destructive and disabling disease, have expanded over recent years. These have been summarised in general strategic suggestions and specific management recommendations, emphasising the importance of expedient disease-modifying antirheumatic drug implementation and tight disease control. This consensus statement is in line with these fundamental principles of management.

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“…The targeting of alternative immune pathways following B-cell depletion was evaluated in a recent preliminary analysis that sought to determine whether such patients demonstrated increased serious infection events (SIEs) [59 ]. The rates (events per 100 patient-years) of SIE while on RTX, but before initiation of a biologic DMARD, were calculated and compared with rates after initiating a new biologic.…”

Section: Biologic Dmards After Rituximabmentioning

confidence: 99%