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Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis
  1. Maya H Buch1,2,
  2. Josef S Smolen3,4,
  3. Neil Betteridge5,
  4. Ferdinand C Breedveld6,
  5. Gerd Burmester7,
  6. Thomas Dörner7,
  7. Gianfranco Ferraccioli8,
  8. Jacques-Eric Gottenberg9,
  9. John Isaacs10,
  10. Tore K Kvien11,
  11. Xavier Mariette12,
  12. Emilio Martin-Mola13,
  13. Karel Pavelka14,
  14. Paul P Tak15,
  15. Desiree van der Heijde6,
  16. Ronald F van Vollenhoven16,
  17. Paul Emery1,2,
  18. for the Rituximab Consensus Expert Committee
  1. 1Section of Musculoskeletal Diseases, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  2. 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  4. 4Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
  5. 5Arthritis Care, UK
  6. 6Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  7. 7Department of Rheumatology and Clinical Immunology, Humboldt University, Charite Hospital, Berlin, Germany
  8. 8Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
  9. 9Rheumatology Department, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
  10. 10Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
  11. 11Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  12. 12Institut Pour la Santé et la Recherche Médicale (INSERM) U 1012, Hôpital Bicêtre, Université Paris-Sud 11, Paris, France
  13. 13La Paz Hospital, Madrid, Spain
  14. 14Institute of Rheumatology and Clinic of Rheumatology Charles University, Prague, Czech Republic
  15. 15Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  16. 16Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
  1. Correspondence to Professor Josef S Smolen, Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria; josef.smolen{at}wienkav.at

Abstract

Background Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab in the treatment of RA.

Methods Preparation of this new document involved many international experts experienced in the treatment of RA. Following a meeting to agree upon the core agenda, a systematic literature review was undertaken to identify all relevant data. Data were then interrogated by a drafting committee, with subsequent review and discussion by a wider expert committee leading to the formulation of an updated consensus statement. These committees also included patients with RA.

Results The new statement covers wide-ranging issues including the use of rituximab in earlier RA and impact on structural progression, and aspects particularly pertinent to rituximab such as co-medication, optimal dosage regimens, repeat treatment cycles and how to manage non-response. Biological therapy following rituximab usage is also addressed, and safety concerns including appropriate screening for hepatitis, immunoglobulin levels and infection risk. This consensus statement will support clinicians and inform patients when using B-cell depletion in the management of RA, providing up-to-date information and highlighting areas for further research.

Conclusion New therapeutic strategies and treatment options for RA, a chronic destructive and disabling disease, have expanded over recent years. These have been summarised in general strategic suggestions and specific management recommendations, emphasising the importance of expedient disease-modifying antirheumatic drug implementation and tight disease control. This consensus statement is in line with these fundamental principles of management.

This paper is freely available online under the BMJ Journals unlocked scheme, see http://ard.bmj.com/info/unlocked.dtl

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Footnotes

  • The first two authors contributed equally.

  • Rituximab Consensus Expert Committee Jordi Carbonell Abello (Spain), Marwan Bukhari (UK), Harald Burkhardt (Germany), Bernard Combe (France), Juan-Jesus Gomez-Reino Carnota (Spain), Leonor Barile Fabris (Mexico), Lars Klareskog (Sweden), Jose Luis Marenco de la Fuente (Spain), Carlo-Maurizio Montecucco (Italy), Mikkel Ostergaard (Denmark), Eliseo Pascual Gomez (Spain), Raimon Sanmarti Sala (Spain), Hans-Peter Tony (Germany), Guido Valesini (Italy), Jaap van Laar (UK), Piet van Riel (The Netherlands).

  • Funding Hoffmann-La Roche provided an unrestricted educational grant to facilitate the development of this document. The views expressed in this guidance document including the final recommendations were not influenced by the sponsor and no representative of the sponsor was present in any of the discussion sessions.

  • Competing interests All participants except the patient representative have been active on advisory boards or participated in clinical trials by the sponsor.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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