Keywords : Rituximab
Efficacy, Safety and Predictors of Response to Rituximab in Treatment of Iraqi Patients with Active Rheumatoid Arthritis
Al- Anbar Medical Journal,
2019, Volume 15, Issue 1, Pages 16-21
Background: Rituximab (RTX) is an anti-CD20 chimeric monoclonal antibody which effectively depletes B cells and is used for treating rheumatoid arthritis (RA). Objectives: To assess the efficacy and safety of RTX and to evaluate the predictors of response to RTX in the treatment of Iraqi patients with active RA. Materials and methods: An open-labeled single group study that was conducted over 13 months in 65 patients with RA diagnosed according to a 1987 American College of Rheumatology (ACR) criteria. All patients were given 4 doses RTX by intravenous infusion over 6 months 1gm/dose. Each patient was followed at each visit of disease activity, including the Clinical Disease Activity Index (CDAI) and functional class (F Class). Also, we assess 9 different patients’ characteristics (age, gender, disease duration, the presence of RF, presence of ACPA, smoking status, previous use of TNF-blocker, the use of methotrexate and BMI) as predictors to RTX. Results: Data analysis showed significant improvement in CDAI (P value=0.005) and functional disability (P-value =0.001), and ESR (P-value =0.005) with RTX use over 6 months. The analysis also showed that smoking has a negative correlation with response to treatment (p-value = 0.005). A better response was seen in RF-positive group. The other variables had no effects on the response to treatment. The patients who switched from TNF-blocker were (29), and the patients who started on RTX were 36 (either due to positive Purified Protein Derivative of a tuberculin test (PPD) or unavailability of TNF-blocker), results showed same RTX efficacy in both groups. Conclusion: RTX is effective both clinically (CDAI and F Class) and laboratory (ESR). It is more effective in patients who are not smokers, and in those who are seropositive for RF. RTX is relatively safe with few side effects, tolerable by most patients. The most common side effect is a transfusion reaction in the form of a sore throat.