Session Type: Abstract Submissions (ACR)
Background/Purpose: Rituximab is a safe and effective treatment in rheumatoid arthritis (RA), however the current treatment regimen requires to wait for a clinical relapse before a new course of treatment. The interval between two courses of treatment varies from one patient to another and remains unknown prior to the treatment. Our aim was to evaluate the utility of following-up different B cells subtypes depletion as a tool to foresee RA clinical relapse. Our aim was to assess the usefulness of periodical B cell analysis to determine if it may predict clinical relapse of RA in patients treated with rituximab.
Methods: Prospective single-center observational study of 39 patients with RA treated with rituximab 1g twice 15 days apart. Patients were monitored clinically and biologically every 2 months until retreatment. Clinical assessment consisted of RA activity and report of adverse event, biological assessment consisted of inflammatory parameters, antibodies, gammaglobulins titres and B cell analysis. The clinician was blinded of the B cell analysis results.
Results: 39 patients were included from March 2010 to December 2011 with a follow-up until January 2013. 7 patients had two courses of treatment and a total of 46 cycles of rituximab were analysed. At baseline mean DAS 28 was 5,44 ; 33 patients were RF and/or ACPA positive. At 6 months, 44 patients (96%) had a good-to-moderate clinical response according to the EULAR criteria. The mean treatment duration was 13 months.
After the two infusions, total number of CD19+ cells decreased (0.155G/l vs 0.0002G/l, p=0.006) with a complete depletion for all patients in the memory (CD19+27+) and transitional subtypes (CD19+CD38++CD24++) (p<0.0001). At relapse B cells were detected in all but 1 patient. Significant majority of patients relapsed within the 4 months that follows B cell CD19+ increase (p=0,04). Looking at B cell subtypes, significant majority of patients relapsed within the 4 months that follows increase in CD19+CD27+ (p=0,01) and increase in CD19+CD38++CD24++ (p=0,007)
Conclusion: Increase in peripheral B lymphocytes after initial depletion appeared to be predictive of a clinical relapse in the next four months, providing objective elements on a forthcoming clinical relapse.
A. P. Trouvin,
X. Le Loët,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/b-cell-analysis-is-an-essential-tool-to-anticipate-clinical-relapse-in-rheumatoid-arthritis-patients-treated-with-rituximab/