If TNFi Attempt Falls Short in RA, Try RTX Next

Among rheumatoid arthritis (RA) patients who discontinue their first tumor necrosis factor inhibitor (TNFi) treatment because it is ineffective, rituximab provides significantly better results than a different TNFi.

Emery P, Gottenberg JE, Rubbert-Roth A, et al., Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previous TNF inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study. Ann Rheum Dis (2014) doi:10.1136/annrheumdis-2013-203993. [Online first Jan 17]

A global study shows that rheumatoid arthritis patients with an inadequate response or intolerance to initial treatment with a tumor necrosis factor inhibitor (TNFi) do better when switched to rituximab (RTX) than to a second TNFi.

The prospective study of more than 1,000 RA patients seen in real-life clinical practices in 11 countries found that RTX significantly improved disease activity scores in 28 joints erythrocyte sedimentation rate (DAS28-3–ESR) compared to an alternative TNFi.

Almost 70% of the RTX patients had a DAS28-3-ESR improvement of least 0.6 points from baseline, and 38.5% saw an improvement of least 1.6 points,  compared with 59.1% and 29.4%, respectively, in the TNFi group.

The SWITCH-RA study followed 604 patients put on RTX and 507 given a second TNFi after their initial response fell short or they couldn’t tolerate the initial biologic after around two years of treatment.

DAS28-3-ESR scores were available for 728 patients (RTX n=405; TNFi n=323) after six months.

A majority (74.4%) had discontinued their first TNFi due to inefficacy and around one quarter (23.7%) because of intolerance.

The six-month improvement was especially pronounced in RA patients who stopped their TNFi after it proved ineffective and in the 77% who were seropositive for rheumatoid factor (RF) or anti-citrullinated protein antibodies (ACPA).

Seronegative RTX patients had a slight improvement at six months, but there was no significant difference in improvement among those intolerant to their first TNFi.

The overall incidence of adverse events was similar in both treatment groups (mostly infections or headaches). Serious adverse events, most often musculoskeletal and connective tissue disorders and infections. were slightly more frequent in the RTX Group. Eleven subjects died, but none due to causes related to study treatment.