Background Identification of predictors of clinical response to biologic therapy is a key issue in RA in the current era where the number of new biologic targets and related therapies for RA is rapidly increasing (1). Rituximab (RTX) a monoclonal antibody targeting B cells has proved to be an effective and safe therapy for active established RA resistant to DMARD or anti-TNFs.Previous data has showed that RTX may be beneficial both in sero+ve and sero-ve RA but recently data have showed that active sero+ve RA have better response to RTX compared to sero-ve.However no detailed data are presently available for clinical response with respect to male and female patients to RTX in sero+ve and sero-ve group.
Objectives The objective of this analysis was to compare DAS28 score between genders in both sero+ve and sero-ve RA patients, in the context of European League against Rheumatism (EULAR) criteria.
Methods Patients with RA treated with RTX within Kent Rheumatology Network in SE England in 6 different hospitals were identified from records dating back to 2006. All 142 patients had at least 6 months follow-up after their 1st course of RTX (dosage 1000mg on day 1 and 15) for active RA. Data was analysed for age, sex, disease duration, prior DMARD,anti-TNF treatment, positivity of RF anti-CCP antibodies in both the gender group.
Results Baseline Data: 86 patients with sero+ve RA (RF+ve or CCP+ve or both) 25 male 61 females. Male had higher pretreatment CRP mean of 22 compared to 14 in females (p=0.07) Male had less DMARDs prior to RTX 5.2 (SD1.1) compared to female patients 5.5 (SD1.6) Prior to treatment with RTX male had slightly lower DAS28 score mean 6.0 compared to 6.2 for female. Mean TNF failure was less in male 1.5 compared to 1.7 in females. Men had more Erosive disease 63% compared to female 52%.Females had longer disease duration with median of 12 years compared to 9 for males (p=0.001). 56 sero-ve RA (male 16 females 41) all RF-ve and CCP-ve. No difference between genders for number of TNF failures, previous DMARDs nor pretreatment inflammatory markers. Men had more erosive disease 38% compared to females 23%. Post RTX Response (6 months): In the sero+ve post treatment DAS was lower in male mean 3.2 compared to 3.9 (p=0.04) in females and reduction in DAS was greater in male mean 2.6 compared to 2.0 in females (p=0.02) In the sero-ve, men had significantly lower DAS mean 4.1 compared to 5.4 (p=0.02) in females and also reduction was greater in males mean 1.4 compared to females which was only 0.5 (p=0.02)
Conclusions This study shows men have better response to RTX.Even in the sero-ve group men showed lower post DAS28 score and better mean reduction.Men had more erosive disease in both the sero+ve and sero-ve group. This study suggests that gender/male can be used as a predictor of response to RTX as with other predictors such as (RF and CCP) and lesser number of TNF used but certainly more studies need to be done involving larger cohort of patients.
Panayi GS.Developments in the immunology of rheumatoid arthritis a personal perspective Rheumatol May 2011 50:815-7
Disclosure of Interest None Declared