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

• Published in: Rheumatology international Vol. 28; no. 1; pp. 33 - 37
• Main Authors: Henes, J C, Richter, C, Kanz, L, Koetter, I
• Format: Journal Article
• Language: English
• 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
• DOI: 10.1007/s00296-007-0376-8
• ISSN: 0172-8172

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.