Background Current approach to treatment with rituximab in RA is treat to target1. Rituximab requires repeat cycles, usually given as fixed retreatment or on clinical relapse. We have followed a retreat on relapse protocol for ten years
Objectives To establish different patterns of response with rituximab in RA and there by develop a predictive pathway for retreatment in conjunction with a biomarker
Methods All RA patients treated with rituximab from our center from November 2002 to December 2012 are included in overall analysis for timing to retreatment and survival on the drug. A subgroup analysis of 119 patients was done to establish pattern of response. Disease activity has been measured using DAS28 and EULAR response. High B cell depletion measured at baseline and at 2 weeks as described in previous paper2.
I and II was used to classify complete depletion or not respectively at 2 weeks, while A and B has been used to depict clinical response (both EULAR GOOD or MOD) or not respectively, e.g. IIB is non depletion non –response, IA depletion good response
Results Overall response
483 patients have been treated so far from November 2002 to December 2012. 416 had 2 cycles, 309 had 3 cycles, 201 had 4 cycles, 123 had 5cycles and 85 had 6 cycles of rituximab.
The mean (SEM) duration of response to cycles of rituximab remains similar C1[50.6(1.32)],C2[50.6(1.3)],C3[53(1.4)],C4[50.5(1.8)],C6[49.1(1.7)].
In ten years of treatment with rituximab about 70% patients remained on the drug while 25.8% had stopped, switched or died (0.6%, 15.3%, 9.9%). Among 47 patients who died, 7 died within 24 weeks of infusion (usually accepted as maximum period of complete B cell depletion). 3/7 died from infection, of whom 1 had low IgG after 6 cycles (5.5 g/l). Overall persistence on drug at 2 years was 88% with 58 events (24 deaths, 34 switch)
Pattern of response to retreatment
There was longer duration of response in subsequent cycles patients with initial complete depletion and response (IA). A significant number of patients with incomplete depletion at 2 weeks and no clinical response (IIB) in cycle 1 responded on subsequent cycles.
Conclusions IA response is associated with prolonged persistence on rituximab. IIB should be retreated with at least one further cycle of rituximab in order to assess if response can be regained
Retreatment with rituximab based on a treat to target approach. Emery P et alRheumatologyDec2011
High sensitivity B cell analysis predicts response to rituximab in RA.Dass S et al, A&R.October 2008
Disclosure of Interest S. Das: None Declared, K. Takase: None Declared, S. Dass Speakers bureau: Roche, M. Buch Consultant for: Honorary/Advisory board, Abbot, Pfizer, Roche, Chugai, BMS, UCB, E. Vital Grant/research support from: Honorarium Roche, P. Emery Consultant for: Honorary/Advisory board, Abbot, Pfizer, Roche, Chugai, BMS, UCB, MSD
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