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

## Abstract

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.

## Supplementary information

### 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). https://doi.org/10.1038/ncprheum0905

• Accepted:

• Published:

• Issue Date:

• ### Established rheumatoid arthritis: Rationale for best practice – Physicians’ perspective of how to realise tight control in clinical practice

• S.C. Horton
• , C.A.E. Walsh
•  & P. Emery

Best Practice & Research Clinical Rheumatology (2011)