ABSTRACT

To determine the effect of rituximab on symptoms and laboratory findings in active rheumatoid arthritis patients resistant to disease modifying drugs (DMARDs) and/or TNF-alpha antagonists.

Patients with erosive and deforming RA who had an inadequate response to ≥2 DMARDs and/or ≥1 TNF-alpha antagonists and treated with rituximab were evaluated retrospectively. Improvement in disease activity, treatment related effects and adverse events were analysed.

Among the 32 patients who were evaluated, 81% were seropositive, 27 received rituximab after TNF antagonists and 5 received it as a first biological agent due to concerns related to TNF-alpha antagonist use in patients with malignancies. At 24 weeks, DAS28 scores decreased significantly but moderate disease activity continued. Based on the EULAR response criteria >60% of the patients achieved a good response. Daily dose of glucocorticoids could be reduced in 6 patients. Eight patients had low IgM, 1 had an infusion reaction, 2 had herpes zoster infections, 2 died due to comorbidities.

Although rituximab was well-tolerated and effective in active RA patients resistant to DMARDs and TNF-alpha antagonists, moderate disease activity continued in the majority of patients despite treatment.