Rheumatoid factor positivity rather than anti-CCP positivity, a lower disability and a lower number of anti-TNF agents failed are associated with response to rituximab in rheumatoid arthritis

• Published in: Rheumatology (Oxford, England) Vol. 48; no. 12; pp. 1557 - 1559
• Main Authors: Quartuccio, Luca, Fabris, Martina, Salvin, Sara, Atzeni, Fabiola, Saracco, Marta, Benucci, Maurizio, Cimmino, Marco, Morassi, Pia, Masolini, Paola, Pellerito, Raffaele, Cutolo, Maurizio, Puttini, Piercarlo Sarzi, De Vita, Salvatore
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.12.2009
• Subjects: Adult; Aged; Aged, 80 and over; Anti-CCP; Anti-TNF; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - immunology; Autoantibodies - blood; Biological and medical sciences; Biomarkers - blood; Disability Evaluation; Diseases of the osteoarticular system; DMARDs; Female; Humans; Immunomodulators; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Patient Selection; Peptides, Cyclic - immunology; Pharmacology. Drug treatments; Prognosis; Retrospective Studies; Rheumatoid arthritis; Rheumatoid factor; Rheumatoid Factor - blood; Rituximab; Treatment Failure; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult; Antineoplastic agent; Immunopathology; Diseases of the osteoarticular system; Positivity; Rheumatology; Anti-TNF; Rituximab; Autoimmune disease; Inflammatory joint disease; Anti-CCP; DMARDs; Immunomodulator; Disability; Rheumatoid factor; Chronic; Rheumatoid arthritis; Immunosuppressive agent
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kep314

Objectives. We explored clinical factors associated with a major response to rituximab (RTX) (e.g. ACR ⩾50, and European League against Rheumatism (EULAR) moderate to good response) in patients with active long-standing RA and inadequate response to anti-TNF agents or traditional DMARDs. Methods. RTX was used in 110 RA patients in six different Italian centres. The mean disease activity score on 28 joints (DAS28) was 6.4 ± 0.99 and the mean HAQ was 1.63 ± 0.68 at baseline. Thirty-two patients (29.1%) underwent RTX after the failure of DMARD therapy, 37 (33.6%) had failed or were intolerant to at least two anti-TNF agents, and 41 (37.3%) had failed or were intolerant to one anti-TNF agent. Univariate and multivariate analyses were performed. Results. The number of previous anti-TNF agents (P = 0.043), HAQ (P = 0.023), RF positivity (P < 0.0001) and anti-cyclic citrullinated peptide (anti-CCP) positivity (P = 0.003) were associated with ACR response ⩾50 between month +4 and month +6 after starting RTX by univariate analysis. Multivariate analysis confirmed that a lower HAQ, a lower number of anti-TNF agents failed before RTX and RF positivity, but not anti-CCP positivity, were the selected variables associated with an ACR response ⩾50, with an accuracy of 84% of the model. Only RF positivity correlated with EULAR moderate to good response both in the univariate and in the multivariate analysis, with an accuracy of 79% of the model. Conclusion. RF-positive rather than anti-CCP-positive RA patients with lower baseline disability and a lower number of previously failed TNF blockers may be the best candidates to RTX.