Which subgroup of patients with rheumatoid arthritis benefits from switching to rituximab versus alternative anti-tumour necrosis factor (TNF) agents after previous failure of an anti-TNF agent?

被引：125

作者：

Finckh, A. ^{[1
]}

Ciurea, A. ^{[2
]}

Brulhart, L. ^{[1
]}

Moller, B. ^{[3
]}

Walker, U. A. ^{[4
]}

Courvoisier, D. ^{[5
]}

Kyburz, D. ^{[2
]}

Dudler, J. ^{[6
]}

Gabay, C. ^{[1
]}

机构：

[1] Univ Hosp Geneva, Dept Internal Med, Div Rheumatol, CH-1211 Geneva 14, Switzerland

[2] Univ Zurich Hosp, Dept Rheumatol, CH-8091 Zurich, Switzerland

[3] Univ Hosp Bern, Dept Rheumatol Clin Immunol & Allergy, CH-3010 Bern, Switzerland

[4] Univ Basel Hosp, Div Rheumatol, CH-4031 Basel, Switzerland

[5] Univ Hosp Geneva, Div Clin Epidemiol, Geneva, Switzerland

[6] Univ Lausanne Hosp, Div Rheumatol, Lausanne, Switzerland

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2010年 / 69卷 / 02期

基金：

瑞士国家科学基金会;

关键词：

PHASE-III TRIAL; MONOCLONAL-ANTIBODY; CONCOMITANT METHOTREXATE; INADEQUATE RESPONSE; CLINICAL-PRACTICE; FACTOR THERAPY; INFLIXIMAB; ETANERCEPT; EFFICACY; RECEPTOR;

D O I：

10.1136/ard.2008.105064

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Patients with rheumatoid arthritis (RA) with an inadequate response to TNF antagonists (aTNFs) may switch to an alternative aTNF or start treatment from a different class of drugs, such as rituximab (RTX). It remains unclear in which clinical settings these therapeutic strategies offer most benefit. Objective: To analyse the effectiveness of RTX versus alternative aTNFs on RA disease activity in different subgroups of patients. Methods: A prospective cohort study of patients with RA who discontinued at least one aTNF and subsequently received either RTX or an alternative aTNF, nested within the Swiss RA registry (SCQM-RA) was carried out. The primary outcome, longitudinal improvement in 28-joint count Disease Activity Score (DAS28), was analysed using multivariate regression models for longitudinal data and adjusted for potential confounders. Results: Of the 318 patients with RA included; 155 received RTX and 163 received an alternative aTNF. The relative benefit of RTX varied with the type of prior aTNF failure: when the motive for switching was ineffectiveness to previous aTNFs, the longitudinal improvement in DAS28 was significantly better with RTX than with an alternative aTNF (p = 0.03; at 6 months, -1.34 (95% CI -1.54 to -1.15) vs -0.93 (95% CI -1.28 to -0.59), respectively). When the motive for switching was other causes, the longitudinal improvement in DAS28 was similar for RTX and alternative aTNFs (p = 0.40). These results were not significantly modified by the number of previous aTNF failures, the type of aTNF switches, or the presence of co-treatment with a disease-modifying antirheumatic drug. Conclusion: This observational study suggests that in patients with RA who have stopped a previous aTNF treatment because of ineffectiveness changing to RTX is more effective than switching to an alternative aTNF.

引用

页码：387 / 393

页数：7

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