Which subgroup of patients with rheumatoid arthritis benefits from switching to rituximab versus alternative anti-tumour necrosis factor (TNF) agents after previous failure of an anti-TNF agent?
| Autor: | Finckh, A, Ciurea, A, Brulhart, L, Möller, B, Walker, U A, Courvoisier, D, Kyburz, D, Dudler, J, Gabay, C, Arthritis, on the behalf of the doctors of the Swiss Clinical Quality Management Programme for Rheumatoid |
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| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Oncology
Male Severity of Illness Index Arthritis Rheumatoid Antibodies Monoclonal Murine-Derived 0302 clinical medicine Immunopathology Immunology and Allergy 030212 general & internal medicine Antirheumatic Agents/*therapeutic use Prospective Studies Treatment Failure Prospective cohort study Clinical and epidemiological research ddc:616 Antibodies Monoclonal Middle Aged Connective tissue disease Arthritis Rheumatoid/*drug therapy 3. Good health Treatment Outcome Rheumatoid arthritis Antirheumatic Agents Rituximab Female medicine.drug medicine.medical_specialty Tumor Necrosis Factor-alpha/*antagonists & inhibitors Immunology Antibodies Monoclonal/*therapeutic use General Biochemistry Genetics and Molecular Biology 03 medical and health sciences Rheumatology Internal medicine Severity of illness medicine Humans 030203 arthritis & rheumatology Autoimmune disease business.industry Tumor Necrosis Factor-alpha Patient Selection medicine.disease Antigens CD20 business Antigens CD20/immunology |
| Zdroj: | Annals of the Rheumatic Diseases Annals of the Rheumatic Diseases, Vol. 69, No 2 (2010) pp. 387-393 Annals of the Rheumatic Diseases, vol. 69, no. 2, pp. 387-393 |
| ISSN: | 1468-2060 0003-4967 |
| Popis: | Background:Patients with rheumatoid arthritis (RA) with an inadequate response to TNF antagonists (aTNFs) may switch to an alternative aTNF or start treatment from a different class of drugs, such as rituximab (RTX). It remains unclear in which clinical settings these therapeutic strategies offer most benefit.Objective:To analyse the effectiveness of RTX versus alternative aTNFs on RA disease activity in different subgroups of patients.Methods:A prospective cohort study of patients with RA who discontinued at least one aTNF and subsequently received either RTX or an alternative aTNF, nested within the Swiss RA registry (SCQM-RA) was carried out. The primary outcome, longitudinal improvement in 28-joint count Disease Activity Score (DAS28), was analysed using multivariate regression models for longitudinal data and adjusted for potential confounders.Results:Of the 318 patients with RA included; 155 received RTX and 163 received an alternative aTNF. The relative benefit of RTX varied with the type of prior aTNF failure: when the motive for switching was ineffectiveness to previous aTNFs, the longitudinal improvement in DAS28 was significantly better with RTX than with an alternative aTNF (p = 0.03; at 6 months, −1.34 (95% CI −1.54 to −1.15) vs −0.93 (95% CI −1.28 to −0.59), respectively). When the motive for switching was other causes, the longitudinal improvement in DAS28 was similar for RTX and alternative aTNFs (p = 0.40). These results were not significantly modified by the number of previous aTNF failures, the type of aTNF switches, or the presence of co-treatment with a disease-modifying antirheumatic drug.Conclusion:This observational study suggests that in patients with RA who have stopped a previous aTNF treatment because of ineffectiveness changing to RTX is more effective than switching to an alternative aTNF. |
| Databáze: | OpenAIRE |
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