B-cell depletion in patients with rheumatoid arthritis refractant to multiple TNF blockers and the interleukin 1 receptor-antagonist anakinra. Good responses in an extreme negative selection

To evaluate the efficacy of Rituximab in a negatively selected patient cohort, with inadequate response to different disease modifying drugs (DMARDs) and to at least two biologicals. Fifteen patients with severe rheumatoid arthritis with inefficacy of an average of 5 DMARDS and 2.5 TNF antagonists w...

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Bibliographic Details
Published inRheumatology international Vol. 28; no. 1; pp. 33 - 37
Main Authors Henes, J C, Richter, C, Kanz, L, Koetter, I
Format Journal Article
LanguageEnglish
Published Germany Springer Nature B.V 01.11.2007
Subjects
Adult
Aged
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Murine-Derived
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - pathology
B-Lymphocytes - pathology
Clinical trials
Cohort Studies
Female
Follow-Up Studies
Humans
Interleukin 1 Receptor Antagonist Protein - therapeutic use
Lymphocyte Depletion - methods
Male
Medical treatment
Middle Aged
Patient Selection
Rheumatoid arthritis
Rituximab
Severity of Illness Index
Time Factors
Treatment Outcome
Tumor Necrosis Factors - antagonists & inhibitors
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Summary:To evaluate the efficacy of Rituximab in a negatively selected patient cohort, with inadequate response to different disease modifying drugs (DMARDs) and to at least two biologicals. Fifteen patients with severe rheumatoid arthritis with inefficacy of an average of 5 DMARDS and 2.5 TNF antagonists were treated with Rituximab. Eight patients were ineffectively pretreated with Anakinra as well. The disease activity score (DAS28) and the morning stiffness served for assessment of the clinical response. For maintenance treatment different conventional DMARDs were used (4xMTX, 4xLeflunomide, 1xmycophenolate, 1xsirolimus, 1xhydroxychloroquine). At baseline visit the mean DAS 28 was 5.9. The mean duration of morning stiffness was 99.6 min. At month 6 the mean DAS28 was 3.95. Forty percent (6 patients) showed a good and 33% (5 patients) a moderate response. Morning stiffness improved to 43 min. In this negatively selected group of patients Rituximab was safe and effective.
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ISSN:0172-8172
1437-160X
DOI:10.1007/s00296-007-0376-8