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AB0339 Correlation between Clinical and Anti-Destructive Effects of Rituximab (RTM) and B-Cells Count in Rheumatoid Arthritis (RA) Patients
  1. A.V. Pivanova,
  2. G. Lukina,
  3. Y. Sigidin,
  4. A.V. Smirnov,
  5. K.Kh. Kuzikyants,
  6. A.Yu. Kuznetsova
  1. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation

Abstract

Background Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation of the synovial tissue and destruction of the cartilage and bone. Antirheumatic treatment plays a important role in controlling the inflammation of rheumatoid arthritis and in minimizing joint damage. Rituximab has been successfully used to treat rheumatoid arthritis. It is a chimeric monoclonal antibody that targets the CD20 molecule expressed on the surface of B cells. Noteworhty, clinical and antidestructive effects often did not coincide.

Objectives To study the impact of B-cells depleting therapy (RTM) on joint destruction in correlation with clinical effects and B-cells counts.

Methods The study included 61 RA pts (average disease duration 10,1±7,7 y., mean DAS28 6,3±0,94, RF-positive 87%, ACCP–positive 93%) undergoing RTM therapy. Clinical effect was scored by EULAR criteria, radiographic progression was assessed using Sharp/van der Heijde (SvH) modified scoring method. B-cell level was measured with flow cytometry.

Results By Week 48 after 2 RTM courses good response was documented in 29,7% pts, good and satisfactory in 85,3%; remission was achieved in 14,6% pts. There was no radiographic progression in remission pts., in 83% of pts with low disease activity and in 33% - with moderate disease activity. Of note, further progression in joint space narrowing was more pronounced than bony tissue destruction - in 32% and 25%m respectively. Clinical and anti-destructive effects were often dis-matching: bone destruction was abrogated without any clinical improvement in 54% of pts. There was no significant difference in clinical effects of RTM dosing regimens (1000mg x2 or 500mg x2). More potent anti-destructive effect was documented in pts getting higher RTM dose values. No significant influence of B-cells depletion on radiographic progression of the disease was noticed. Although, in RA pts achieving remission B-cell depletion was more notable (Median, IQR 0% (0–1.133) as compared to pts with active disease (Median, IQR 0.8% (0.2–4.8, p 0.001).

Conclusions Clinical and anti-destructive effects of B-cell depletion therapy are not always equivalent. Therapeutic effect of two dosing regimens was similar, but the anti-destructive one was more pronounced with higher RTM doses. Radiographic progression did not show any correlation with the degree of B-cells depletion. Most pronounced B-cells depletion was documented in pts achieving remission.

Disclosure of Interest None declared

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