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Rituximab or a second anti–tumor necrosis factor therapy for rheumatoid arthritis patients who have failed their first anti–tumor necrosis factor therapy? Comparative analysis from the British Society for Rheumatology Biologics Register
Author(s) -
Soliman Moetaza M.,
Hyrich Kimme L.,
Lunt Mark,
Watson Kath D.,
Symmons Deborah P. M.,
Ashcroft Darren M.
Publication year - 2012
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21663
Subject(s) - medicine , rheumatoid arthritis , rituximab , rheumatology , rheumatism , confidence interval , odds ratio , tumor necrosis factor alpha , propensity score matching , physical therapy , gastroenterology , oncology , lymphoma
Objective To compare the effectiveness of rituximab (RTX) or a second anti–tumor necrosis factor (anti‐TNF) therapy in rheumatoid arthritis (RA) patients who had failed their first anti‐TNF and switched to either RTX or a second anti‐TNF, in routine clinical practice. Methods RA patients were registered with the British Society for Rheumatology Biologics Register. Response to treatment 6 months after switching was assessed using European League Against Rheumatism (EULAR) criteria and improvements in a Health Assessment Questionnaire (HAQ) score (0.22 unit or more). Regression analyses were used to compare EULAR response and improvement in HAQ score between the 2 groups, adjusting for propensity scores. Results In total, 1,328 patients were included in the analysis of EULAR response, and 937 patients were included in the analysis of HAQ scores. Six months after switching, 54.8% of patients who switched to RTX were EULAR responders compared to 47.3% of those who switched to a second anti‐TNF. A total of 38.4% of RTX patients achieved a clinically important improvement in HAQ score compared to 29.6% in anti‐TNF patients. After adjustment using propensity scores, patients who switched to RTX were significantly more likely to achieve EULAR response (odds ratio [OR] 1.31; 95% confidence interval [95% CI] 1.02, 1.69) compared to those who switched to an alternative anti‐TNF. RTX patients were also significantly more likely to achieve improvements in HAQ score (OR 1.49; 95% CI 1.07, 2.08). Conclusion The results suggest that switching to RTX may be of more benefit than switching to an alternative anti‐TNF therapy after failing the first anti‐TNF therapy in RA patients.