Skip to content

Advertisement

  • Poster presentation
  • Open Access

Seronegative and seropositive rheumatoid arthritis treated with rituximab

  • 1,
  • 1,
  • 1 and
  • 1
Journal of Translational Medicine201210(Suppl 3):P47

https://doi.org/10.1186/1479-5876-10-S3-P47

Published: 28 November 2012

Keywords

  • Rheumatoid Arthritis
  • Methotrexate
  • Rheumatoid Factor
  • Citrullinated
  • Functional Disability

Background

B cells play a crucial role in the pathogenesis of rheumatoid arthritis (RA). They are responsible for the autoantibodies formation such as rheumatoid factor (RF) and anti- cyclic citrullinated peptide antibodies (anti-CCP) and the production of cytokines, act as antigen presenting cells and regulate T cell functions.

Rituximab (RTX), murine monoclonal antibody which selectively targets CD20-positive B-cells, has proved to be an efective and safe therapy for active RA. Initially it was used in seropositive RA, but considering the other functions of B cells, it is logical to think that it is also useful in seronegative forms.

Objective

To evaluate the efficacy of RTX in our series of refractory seronegative and seropositive RA.

Materials and methods

Baseline characteristics and disease activity markers at baseline, and after 3 and 6 months of treatment with RTX (1 g x 2 weeks), were collected in 33 patients. A descriptive study was made; and the relations between variables were analyzed statistically.

Results

The mean age was 52.06 ± 12.01 years, 75.8% female, 78.8% RF positive (26). The mean duration of illness was 7.70 ± 4.47 years. Thirty-two patientes (97%) had failed at least to one TNF antagonist.

Most of the patients (84.8% 9) received RTX with methotrexate.

The mean DAS28 at baseline was 5.7 ± 1.30; at 3 months decreased to 3.4 ± 1.22, and at 6 months to 4.15 ± 1.69 ( p < 0.0005).

At 3 months, 88.9% reached good eular response, and 63.3% at 6 months. Remission was obtained in 17.2% at 3 months and in 16.7% at 6 months.

It was also noted improvement in baseline HAQ, after 3 and 6 months (from 1.75 ± 0.767 to 0.96 ± 0.56 and 1.24 ± 0.70 respectively).

No significant differences were found between decreases in DAS 28 at 3 and 6 months compared to baseline between RF seronegative and seropositive patients, neither in good eular response, remission percentages or HAQ improvement. The data are shown in the table.

Table 1

 

Mean DAS28 at baseline

Mean DAS28 at 3 months

Mean DAS28 at 6 months

Good eular response at 3 months

Good eular response at 6 months

DAS28 < 2,6 at 3 monts

DAS28<26 at 6 months

HAQ at baseline

HAQ at 3 months

HAQ at 6 months

RF +

5.73 ± 1.24

3.38 ± 1.30

4.13 ± 1.83

90.5%

65.2%

18.2%

17.4%

1.81 ± 0.77

1.00 ± 0.57

1.2 ± 0.74

RF -

5.52 ± 1.61

3.72 ± 0.93

4.22 ± 1.23

83.3%

57.1%

14.3%

14.3%

1.57 ± 0.78

0.83 ± 0.56

0.95 ± 0.54

Discussion

The efficacy and safety of RTX has been proved in several clinical trials.

The presence of RF, low baseline functional disability and no more than one previous anti-TNF are predictors of good response to RTX, as has been recently published.

Response rates in seronegative RA, are slightly lower, although higher than placebo, as described in other publications.

In conclussion, the experience of RTX treatment in our patients with seronegative RA is positive, in terms of efficacy, due to the action on B cells and their different roles, with no significant differences comparing to seropositive RA.

Authors’ Affiliations

(1)
Rheumatology Unit, Valme University Hospital, Seville, Spain

References

  1. Chatzidionysiou K: Highest clinical effectiveness of rituximab in autoantibody-positive patients with rheumatoid arthritis and in those for whom no more than one previous TNF antagonist has failed: pooled data from 10 European registries. Ann Rheum Dise. 2011, 70: 1575-80. 10.1136/ard.2010.148759.View ArticleGoogle Scholar
  2. Tak PP, Cohen SB, CK Saadeh, De Vita S, Donohue JP, Shaw TM: Following the first response Clinical course Treatment with Rituximab: Effect of baseline autoantibody status / RF, anti-CCP). Ann Rheum Dis. 2007, 66 (Suppl II): 338-[Abstract FRI0192]Google Scholar

Copyright

© Velloso Feijoo et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement