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Extended report
Evolution of radiographic joint damage in rituximab-treated versus TNF-treated rheumatoid arthritis cases with inadequate response to TNF antagonists
  1. Axel Finckh1,2,
  2. Burkhard Möller3,
  3. Jean Dudler4,
  4. Ulrich A Walker5,
  5. Diego Kyburz6,
  6. Cem Gabay1 on behalf of the physicians of the Swiss Clinical Quality Management for Rheumatoid Arthritis
    1. 1Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
    2. 2Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland
    3. 3Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Bern, Bern, Switzerland
    4. 4Division of Rheumatology, Fribourg Hospital, Fribourg, Switzerland
    5. 5Department of Rheumatology, Basel University, Basel, Switzerland
    6. 6Department of Rheumatology, University Hospital, Zurich, Switzerland
    1. Correspondence to Dr Axel Finckh, Division of Rheumatology, University Hospital of Geneva, 26 Av. Beau-Sejour, 1211 Geneva 14, Switzerland; axel.finckh{at}hcuge.ch

    Abstract

    Background Observational studies have suggested that patients with rheumatoid arthritis (RA) who experience inadequate response to anti-tumour necrosis factor (anti-TNF) agents respond more favourably to rituximab (RTX) than to an alternative anti-TNF agent. However, the relative effectiveness of these agents on long-term outcomes, particularly in radiographic damage, remains unclear.

    Objective To compare the effectiveness of RTX against anti-TNF agents in preventing joint damage in patients with RA who have experienced inadequate response to at least one prior anti-TNF agent.

    Methods This is a prospective cohort study within the Swiss registry of patients with RA who discontinued at least one anti-TNF agent and subsequently received either RTX or an alternative anti-TNF agent. The primary outcome, progression of radiographic joint erosions (Ratingen erosion score)over time, and the secondary outcome, functional disability (Health Assessment Questionnaire Disability Index), were analysed using regression models for longitudinal data and adjusted for potential confounders.

    Results Of the 371 patients included, 104 received RTX and 267 received an alternative anti-TNF agent. During the 2.6-year median follow-up period, the rates of Ratingen erosion score progression were similar between patients taking RTX and patients taking an alternative anti-TNF agent (p=0.67). The evolution of the Health Assessment Questionnaire score was statistically significantly better in the RTX group (p=0.016), but the magnitude of the effect was probably not clinically relevant.

    Conclusion This observational study suggests that RTX is as effective as an alternative anti-TNF agent in preventing erosions in patients with RA who have previously experienced inadequate response to anti-TNF agents.

    This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

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    Footnotes

    • Ethics approval Swiss Academy of Medical Sciences review board.

    • Data sharing statement The original data for this research are kept in the SCQM registry.

    • Funding Swiss National Science Foundation (and an unrestricted research grant from Roche).

    • Competing interests AF discloses board memberships or payment for lectures for Abbott, BMS, Pfizer, Roche, and Schering- Plough. BM discloses board memberships or grants from Abbott, BMS, Pfizer and Roche. JD discloses consultancies or payment for lectures for Abbott, BMS, MSD, Pfizer, Roche and UCB. UW discloses board memberships or payment for lectures for MSD, Pfizer, Roche and UCB. CG discloses board memberships, consultancies or payment for lectures for Abbott, BMS, MSD, Pfizer, and Roche. DK discloses board memberships, grants or payment for lectures for Abbott, Amgen, BMS, MSD, Pfizer, UCB, and Vifor Pharma.

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

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