Smoking, rheumatoid factor status and responses to rituximab

Khan, Abdul Haseeb; Scott, David; Batley, Mike

doi:10.1136/annrheumdis-2012-201758

Cited by 21 publications

(15 citation statements)

References 10 publications

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“…Smoking is usually associated to a worse therapeutic outcome after steroids (29). Although there are no data in GO, in patients with rheumatoid arthritis, response to RTX has been shown to be less satisfactory in smokers than in non-smokers (30). Therefore, one could presume that the response to RTX would be more significant in the US trial, but that was not the case.…”

Section: Analysis Of the Randomized Trials Characteristicsmentioning

confidence: 81%

MANAGEMENT OF ENDOCRINE DISEASE: Rituximab therapy for Graves’ orbitopathy – lessons from randomized control trials

Stan

Salvi

2017

European Journal of Endocrinology

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Rituximab (RTX) use in open-label series has been associated with very encouraging responses in patients with active and moderate-to-severe Graves' orbitopathy (GO). Recently, randomized controlled trials of RTX have been performed in such patients to answer the question of clinical efficacy and the safety profile of this agent. That data, reported separately, focused on Clinical Activity Score (CAS) and indicated in one trial a strong benefit of RTX in comparison with IV glucocorticoids, whereas the other trial noted the absence of a benefit by comparison with placebo. The outcome was reanalyzed post hoc here, using EUGOGO criteria, and the results were not significantly different. The authors comment further on the differences between the two trials regarding populations treated, methodology, analysis of outcomes and the adverse effect profile of RTX. The populations treated appear different with younger patients, lower TRAb and shorter duration of disease prevalent in the Italian trial, all elements favoring a better response. Smoking, usually diminishing a response, was also more prevalent in some patients. The combined outcome proposed by EUGOGO revealed similar results with CAS regarding RTX efficacy; yet, it might be a more comprehensive outcome. The adverse events of concern relate mainly to the risk of DON, which seems to be increased by the use of RTX in a certain subset of patients. Based on available data, a multicenter trial using the EUGOGO-proposed outcomes might be the next best step to define the role of RTX in GO therapy.

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Section: Analysis Of the Randomized Trials Characteristicsmentioning

confidence: 81%

MANAGEMENT OF ENDOCRINE DISEASE: Rituximab therapy for Graves’ orbitopathy – lessons from randomized control trials

Stan

Salvi

2017

European Journal of Endocrinology

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“…Pack-year history has also been demonstrated to be inversely associated with response 25 27. Current smokers were found only to respond to rituximab if they were RF- or anti-CCP-positive, but response in non-smokers was irrespective of RF/anti-CCP status28 (table 3).…”

Section: Resultsmentioning

confidence: 98%

“…There is now good evidence that current smoking reduces response to anti-TNFα and rituximab therapy, with an association between the level of response and pack-year history 15 23 25–28. Although duration of disease has not been shown to be a predictor of response to biological therapy,19 28 disease activity has been found to be predictive —that is, higher disease activity is associated with better response 11 14 16 29 30. The value of these outcomes in practice remains questionable, as the response is dependent on the measure used.…”

Section: Discussionmentioning

confidence: 99%

Biological therapy for rheumatoid arthritis: is personalised medicine possible?

et al. 2013

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Introduction The management of rheumatoid arthritis (RA) has changed significantly since the introduction of cytokine modulators (biological agents). Approximately 30% of patients with RA fail to respond to treatment. As there is now a choice of agents, it is important to identify what factors may affect a patient's response in order to individualise management, thereby optimising outcomes, minimising risks and maximising cost-effectiveness. Methods A literature search was undertaken with the search terms, ‘biological agents’, ‘biological therapy’, ‘RA’, ‘prediction’ and ‘response’, using Medline, Embase, the British Society for Rheumatology Biologics Register (BSRBR) website and the review journal Current Opinion in Rheumatology. In addition, a final search using specific drug names (abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab and tocilizumab) was performed. Results A total of 154 papers were identified. Subsequently, 62 were rejected as not addressing response, 12 were not full papers, and 35 were not considered relevant. A total of 45 studies were reviewed. There are data concerning the predictive value of age (younger age positive predictor), gender (female predictive of non-response to rituximab), disease activity (high baseline Disease Activity Score predictive of remission), functional ability (lower baseline disability predictive) and concomitant methotrexate therapy (positive predictor). Conversely, disease duration and previous number of disease-modifying antirheumatic drugs have not been found to be predictive of response. Some factors, although associated with response, were not demonstrated to be predictive —for example, autoantibodies, smoking status and the development of antibodies to drugs. Conclusions Identification of predictive factors, in addition to increasing knowledge of factors that may affect response, can be used to take a more personalised approach to therapeutic choice for patients with RA who require biological therapy.

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“…( b ) Impact of smoking status with ACPA positivity during rituximab therapy showing only non-smokers had major benefit 30 .…”

Section: Present Uncertaintiesmentioning

confidence: 99%

Developing new therapeutic approaches for rheumatoid arthritis: the continuing challenges of clinical assessments

Scott

2016

F1000Res

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The management of rheumatoid arthritis has changed dramatically over the last three decades. Improvements in clinical assessment have been a key driver of these changes. However, in the last five years, three areas of unresolved uncertainty have dominated specialist thinking in the field. These challenges comprise identifying the optimal management target, determining how best to reach this target by using intensive treatments, and individualising management because not all patients need or respond to identical treatments. The key problem that links each of these areas is balancing different types of evidence and is most readily appreciated in relation to treatment intensity. Giving more intensive therapy improves outcomes but also increases risks and, with biologic treatments, substantially increases drug costs. Specialists and healthcare funders need to agree on how best to rationalise optimal care for patients with what is most effective and safe and what is affordable.

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Smoking, rheumatoid factor status and responses to rituximab

Cited by 21 publications

References 10 publications

MANAGEMENT OF ENDOCRINE DISEASE: Rituximab therapy for Graves’ orbitopathy – lessons from randomized control trials

MANAGEMENT OF ENDOCRINE DISEASE: Rituximab therapy for Graves’ orbitopathy – lessons from randomized control trials

Biological therapy for rheumatoid arthritis: is personalised medicine possible?

Developing new therapeutic approaches for rheumatoid arthritis: the continuing challenges of clinical assessments

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