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Predictive Factors of Rituximab Response in Rheumatoid Arthritis: Results From a French University Hospital
Author(s) -
Couderc M.,
Mathieu S.,
Pereira B.,
Glace B.,
Soubrier M.
Publication year - 2013
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.21865
Subject(s) - medicine , rheumatoid arthritis , rituximab , rheumatoid factor , rheumatism , confidence interval , gastroenterology , univariate analysis , odds ratio , multivariate analysis , immunology , lymphoma
Objective To study the influence of several factors (rheumatoid factor [RF], anti–cyclic citrullinated peptide [anti‐CCP], serum Ig level, and Epstein‐Barr virus [EBV] load) on clinical response to rituximab (RTX) after 6 months in rheumatoid arthritis (RA) patients. Methods Sixty‐four patients receiving RTX (two 1‐gm doses 2 weeks apart) for active RA were prospectively included. RF, anti‐CCP, gamma globulin level, and EBV load were assessed prior to the first RTX cycle. Clinical responses were analyzed 6 months after RTX initiation using the European League Against Rheumatism criteria. Univariate and multivariate analyses were performed to identify factors associated with RTX response at 6 months. Results The mean disease duration was 16.4 years and 46 patients (71.9%) had already received at least 1 anti–tumor necrosis factor agent prior to RTX. At 6 months, 46 patients (71.9%) had a good to moderate response to RTX. Anti‐CCP positivity was associated with a good to moderate response (odds ratio [OR] 4, 95% confidence interval [95% CI] 1.04–15.5; P = 0.04). RF positivity ( P = 0.26) and positive initial EBV load ( P = 0.16) were not associated with a good to moderate response. Hyperimmunoglobulin was correlated with a poorer response to RTX than normal Ig levels (OR 0.04, 95% CI 0.005–0.28; P = 0.002). Conclusion Anti‐CCP positivity was a predictor of good to moderate response to RTX in RA patients. On the other hand, high Ig levels were associated with a poorer outcome in contrast to previous findings. Further support from larger studies is necessary so as to optimize the management of the RA patients with high Ig levels.