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Which subgroup of rheumatoid arthritis patients benefits from switching to rituximab versus alternative anti-TNF agents after previous failure to anti-TNF agent?
  1. Axel Finckh (axel.finckh{at}hcuge.ch)
  1. University Hospital of Geneva, Switzerland
    1. Adrian Ciurea (adrian.ciurea{at}usz.ch)
    1. University Hospital of Zurich, Switzerland
      1. Laure Brulhart (brulhart-laure{at}diogenes.hcuge.ch)
      1. University Hospital of Geneva, Switzerland
        1. Diego Kyburz (diego.kyburz{at}usz.ch)
        1. University Hospital of Zurich, Switzerland
          1. Burkhard Moeller (burkhard.moeller{at}insel.ch)
          1. University Hospital of Bern, Switzerland
            1. Ulrich A Walker (ulrich.walker{at}fps-basel.ch)
            1. University Hospital of Basel, Switzerland
              1. Delphine Courvoisier (courvoisier-delphine{at}diogenes.hcuge.ch)
              1. University Hospital of Geneva, Switzerland
                1. Jean Dudler (jean.dudler{at}chuv.ch)
                1. University Hospital of Vaud, Switzerland
                  1. Cem Gabay (cem.gabay{at}hcuge.ch)
                  1. University Hospital of Geneva, Switzerland

                    Abstract

                    Background: Rheumatoid arthritis (RA) patients with an inadequate response to TNF inhibitors (aTNF) may switch to an alternative aTNF or start a treatment from a different class, such as rituximab (RTX). It remains unclear in which clinical settings these therapeutic strategies offer most benefit.

                    Objective: To analyze the effectiveness of RTX versus alternative aTNFs on RA disease activity in different subgroups of patients.

                    Methods: This is a prospective cohort study of RA patients who discontinued at least one aTNF and subsequently received either RTX or an alternative aTNF, nested within the Swiss RA registry (SCQM-RA). The primary outcome, longitudinal improvement in DAS28, was analysed using multivariate regression models for longitudinal data and adjusted for potential confounders.

                    Results: Of the 318 RA patients included; 155 received RTX and 163 received an alternative aTNF. The relative benefit of RTX varied with the type of prior aTNF failure: when the motive for switching was ineffectiveness to previous aTNFs, the longitudinal improvement in DAS28 was significantly better with RTX than alternative aTNF (p = 0.03; at 6 months, –1.34 (95% CI: –1.54; –1.15) versus –0.93 (95% CI: –1.28; –0.59) respectively). When the motive for switching was other causes, the longitudinal improvement in DAS28 was similar between RTX and alternative aTNFs (p =0.40). These results were not significantly modified by the number of previous aTNF failures, the type of aTNF switches, or the presence of DMARD co-therapy.

                    Conclusion: This observational study suggests that RTX is more effective than switching to an alternative aTNF in RA patients who stopped a previous aTNF treatment because of ineffectiveness.

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