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Is rituximab suitable for use as a first-line biologic therapy for RA?


Rituximab is approved for the treatment of patients with rheumatoid arthritis (RA) who are unresponsive to anti-tumor necrosis factor (TNF) therapy. McGonagle et al. presented a series of patients treated in everyday clinical practice with rituximab as the first biologic agent—that is, before anti-TNF therapy. The patients did well in terms of improvements in signs and symptoms of RA. There was one death that was probably a result of infection, but otherwise the rituximab therapy was well tolerated. Appropriately, the authors did not endorse rituximab as a first-line agent for RA patients in general, but concluded that rituximab was a reasonable option in situations where anti-TNF agents either could not be obtained, or where there was concern about their toxicity. We agree with the authors—there are circumstances where rituximab might be used in patients who have not received anti-TNF therapy, but there are insufficient data to support a change in the pre-eminent position of anti-TNF agents in the current standard of care.

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  1. 1

    McGonagle D et al. (2008) Rituximab use in everyday clinical practice as a first-line biologic therapy for the treatment of DMARD-resistant rheumatoid arthritis. Rheumatology (Oxford) 47: 865–867

    CAS  Article  Google Scholar 

  2. 2

    Cohen SB et al. (2006) Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary safety and efficacy at twenty-four weeks. Arthritis Rheum 54: 2793–2806

    CAS  Article  Google Scholar 

  3. 3

    Emery P et al. (2006) The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial. Arthritis Rheum 54: 1390–1400

    CAS  Article  Google Scholar 

  4. 4

    Keystone EC et al. (2004) Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial. Arthritis Rheum 50: 1400–1411

    CAS  Article  Google Scholar 

  5. 5

    Keystone EC et al. (2008) Rituximab inhibits structural joint damage in rheumatoid arthritis patients with an inadequate response to tumour necrosis factor inhibitor therapies. Ann Rheum Dis [10.1136/ard.2007.085787]

  6. 6

    Bongartz T et al. (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295: 2275–2285

    CAS  Article  Google Scholar 

  7. 7

    Looney RJ et al. (2008) The effects of rituximab on immunocompetency in patients with autoimmune disease. Arthritis Rheum 58: 5–14

    CAS  Article  Google Scholar 

  8. 8

    Hauser SL et al. (2008) B-cell depletion with rituximab in relapsing–remitting multiple sclerosis. N Engl J Med 358: 676–688

    CAS  Article  Google Scholar 

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Corresponding author

Correspondence to R John Looney.

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Competing interests

RJ Looney has received consulting fees (less than $10,000 each) from Amgen, Coley, Genentech, IDEC/Biogen, MedImmune, Roche, Trubion and Wyeth. He also participates in multicenter trials sponsored by several of these companies. A Kleiner declared no competing interests.

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Supplementary Table 1

Representative trials of biologic agents for rheumatoid arthritis (XLS 30 kb)

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Kleiner, A., Looney, R. Is rituximab suitable for use as a first-line biologic therapy for RA?. Nat Rev Rheumatol 4, 574–575 (2008).

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