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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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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Kleiner, A., Looney, R. Is rituximab suitable for use as a first-line biologic therapy for RA?. Nat Rev Rheumatol 4, 574–575 (2008). https://doi.org/10.1038/ncprheum0905
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