Objective To compare clinical and antidestructive effect of Rituximab (RTX) in patients with rheumatoid arthritis (RA).
Material and methods Clinical and radiological study of 61 patients (pts) with RA (mean disease duration 10,1 ± 7.7 years, mean DAS28 6.3 ± 0.94, RF-positive 87%, ACCP-positive 93%) treated with RTX (1000 mg x 2 or 500 mg x 2). Clinical effect was assessed by EULAR criteria; radiological progression by SVH method.
Results patients were treated by different doses of RTX (500 × 2 or 1000 × 2) had good response. Good clinical results were registered in 29.7% (remissions – 14.6%) after 48 week of receiving 2 courses of RTX; good and satisfactory results in 85.3%. Whole group achieved a significant slowing of radiological progression in joint damage. After 48 weeks of treatment progression of articular destruction was absent in all pts in clinical remission, in 83% of pts with low disease activity, and in 43% of pts with moderate activity. Narrowing of joint space was more pronounced than bone destruction – 32% and 25% respectively. Clinical and antidestructive effects often did not coincide. Noteworthy, RTX treatment slowed joint damage in 54% of pts without clinical improvement. There were no significant correlations between clinical outcomes and doses of RTX. The high-dose use of PTX (1000 vs 500 × 2 × 2) was associated with a significant slowing radiographic progression.
Conclusion Clinical and antidestructive results did not always coincide which suggests different mechanisms of clinical and antidestructive effects of anti-B-cell therapy. The therapeutic effect of different doses of RTX was practically the same but the antidestructive effect of higher doses was significantly greater.