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Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previous TNF inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study
  1. P Emery1,2,
  2. J E Gottenberg3,
  3. A Rubbert-Roth4,
  4. P Sarzi-Puttini5,
  5. D Choquette6,
  6. V M Martínez Taboada7,
  7. L Barile-Fabris8,
  8. R J Moots9,
  9. A Ostor10,
  10. A Andrianakos11,
  11. E Gemmen12,
  12. C Mpofu13,
  13. C Chung14,
  14. L Hinsch Gylvin13,
  15. A Finckh15
  1. 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
  2. 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Department of Rheumatology, CHU Strasbourg, Strasbourg, France
  4. 4University of Cologne, Cologne, Germany
  5. 5L Sacco University Hospital, Milan, Italy
  6. 6University of Montreal, Montreal, Canada
  7. 7Facultad de Medicina, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
  8. 8Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico
  9. 9Department of Rheumatology, University of Liverpool, Liverpool, UK
  10. 10Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  11. 11Hellenic Foundation for Rheumatological Research, Athens, Greece
  12. 12Quintiles, Rockville, Maryland, USA
  13. 13F Hoffmann-La Roche Ltd, Basel, Switzerland
  14. 14Genentech Inc, San Francisco, California, USA
  15. 15University Hospital of Geneva, Geneva, Switzerland
  1. Correspondence to Professor Paul Emery, Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LMBRU LTHT, Chapel Allerton Hospital, Leeds LS7 4SA, UK; p.emery{at}


Objectives To compare the effectiveness of rituximab versus an alternative tumour necrosis factor (TNF) inhibitor (TNFi) in patients with rheumatoid arthritis (RA) with an inadequate response to one previous TNFi.

Methods SWITCH-RA was a prospective, global, observational, real-life study. Patients non-responsive or intolerant to a single TNFi were enrolled ≤4 weeks after starting rituximab or a second TNFi. Primary end point: change in Disease Activity Score in 28 joints excluding patient's global health component (DAS28-3)–erythrocyte sedimentation rate (ESR) over 6 months.

Results 604 patients received rituximab, and 507 an alternative TNFi as second biological therapy. Reasons for discontinuing the first TNFi were inefficacy (n=827), intolerance (n=263) and other (n=21). A total of 728 patients were available for primary end point analysis (rituximab n=405; TNFi n=323). Baseline mean (SD) DAS28-3–ESR was higher in the rituximab than the TNFi group: 5.2 (1.2) vs 4.8 (1.3); p<0.0001. Least squares mean (SE) change in DAS28-3–ESR at 6 months was significantly greater in rituximab than TNFi patients: −1.5 (0.2) vs −1.1 (0.2); p=0.007. The difference remained significant among patients discontinuing the initial TNFi because of inefficacy (−1.7 vs −1.3; p=0.017) but not intolerance (−0.7 vs −0.7; p=0.894). Seropositive patients showed significantly greater improvements in DAS28-3–ESR with rituximab than with TNFi (−1.6 (0.3) vs −1.2 (0.3); p=0.011), particularly those switching because of inefficacy (−1.9 (0.3) vs −1.5 (0.4); p=0.021). The overall incidence of adverse events was similar between the rituximab and TNFi groups.

Conclusions These real-life data indicate that, after discontinuation of an initial TNFi, switching to rituximab is associated with significantly improved clinical effectiveness compared with switching to a second TNFi. This difference was particularly evident in seropositive patients and in those switched because of inefficacy.

  • Rheumatoid Arthritis
  • DMARDs (biologic)
  • Anti-TNF
  • B cells
  • Treatment

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