Biologic Switching OK for Non Rituximab Responders

May 9, 2016

When considering switching between different classes of biologics, the risk of infection in patients with rheumatoid arthritis is always a concern.

When considering switching between different classes of biologics, the risk of infection in patients with rheumatoid arthritis is always a concern.

“Of particular interest is the time from last rituximab dose to the first dose of the subsequent non-rituximab biologic,” writes Leslie R. Harrold, M.D., with the University of Massachusetts Medical School in Worcester, Mass., in Arthritis Care & Research. “Additionally, in clinical trial settings, patients typically receive repeat doses of rituximab every four to six months, as needed; however, the rate and number of rituximab re-treatments vary in real-world clinical practice.”

To find out whether the time between the last rituximab infusion and initiation of a different biologic influenced infection risk in patients with rheumatoid arthritis in the clinical practice, Harrold and colleagues evaluated patients with rheumatoid arthritis in the Corrona Registry, who newly initiated rituximab and switched to a non-rituximab biologic.

Within Corrona, 215 patients switched to a subsequent biologic after rituximab use. Of these patients, 104 switched to a subsequent medication within five months, while 67 switched in six to 11 months and 44 switched more than a year after their last rituximab infusion. Around 103 patients switched from rituximab to a TNFi, and 112 patients switched from rituximab to a non-TNFi biologic.

Forty-four infections were reported in the 215 patients during the 12-month follow-up, including seven serious infections (defined as requiring intravenous antibiotics or hospitalization). The overall all-infection rates (events per PY) were 0.34, 0.30, and 0.41 for the ≤ 5-month, 6- to 11-month, and ≥ 12-month groups, respectively.

The most common types of non-serious infections observed across all patient groups were upper respiratory infection (n = 15), urinary tract infection (n = 7), and > 1 organ system infection (n = 3; sinusitis/urinary tract infection [n = 1] and urinary tract/upper respiratory tract infection [n = 2]).

“The rate of infection after initiation of the subsequent biologic was not significantly different across these groups, suggesting that there was no increase in risk of infection when switching early (within 5 months of last rituximab infusion) compared with switching later (≥ 1 year after last rituximab infusion),” Harrold said.

 

References:

Leslie R. Harrold, George W. Reed, et al. 

Risk of infection associated with subsequent biologic use after rituximab: Results from a national rheumatoid arthritis patient registry

Arthritis Care & Research

. DOI: 10.1002/acr.22912.