Session Type: Abstract Submissions (ACR)
Background/Purpose: The data on how to optimally retreat patients with RA with rituximab (RTX) have been limited so far. The aim of this analysis was to compare two common retreatment strategies: A fixed retreatment approach (before flare) and retreatment when a flare occurs
Methods: Pooled data from the Collaborating European Registries for Rituximab in RA (CERERRA) project were used. RA patients who received at least 2 retreatments (3 courses) with RTX and for whom information about the strategy for retreatment was available (according to the physician’s opinion) were identified. The two retreatment strategies were compared by applying an adjusted mixed model analysis with DAS28 improvement as the dependent variable.
Results: A total of 800 patients were retreated at least 2 times: 616 retreated because of a flare (442 at 1st and 174 at 2nd retreatment) and 184 receiving fixed retreatment (128 at 1st and 56 at 2nd retreatment). Baseline characteristics (incl. age, sex, seropositivity, disease duration, number of prior DMARDs and biologics) at first course of RTX did not differ significantly between the two groups. However, patients retreated on flare had a significantly higher DAS28-ESR at the time of 1st retreatment (5.1±1.3 vs. 4.1±1.4, p<0.0001), and a higher HAQ (1.5±0.7 vs. 1.3±0.8, p=0.001), as expected. They had also a higher baseline (at the time of RTX start) DAS28 (6.3±1.0 vs. 6.1±1.2, p=0.03). Those retreated on flare were also more likely to be treated with corticosteroids (58% vs. 46%, p=0.01) but less likely to receive concomitant DMARDs (82% vs. 92%, p=0.005).
In figure 1 the baseline (=start of each cycle) DeltaDAS28 (compared to the DAS28 at the time of RTX start) for the two groups is shown. Patients receiving fixed retreatment had a significantly higher (in absolute number) DeltaDAS28 (p<0.0001) at the start of each cycle, compared to those retreated on-flare. In the adjusted mixed model analysis, we compared the two retreatment groups for the 1st and the 2nd retreatment separately using estimated marginal means. For the 1st retreatment a fixed retreatment yielded significantly better results than the “on-flare”: mean DeltaDAS28=-2.4 (95% CI: -3.0; -1.7) vs. -1.8 (95% CI: -3.6; -0.03), p<0.0001. Similar results were found for the 2nd retreatment: mean DeltaDAS28=-2.6 (95% CI: -3.1; -2.2) vs. -1.6 (95% CI: -1.8; -1.4), p<0.0001.
Conclusion: A fixed retreatment strategy with RTX in RA seems to be more effective than the retreat ‘on-flare’ strategy.
Abbott Immunology Pharmaceuticals,
M. L. Hetland,
Pfizer, ROche og MSD.,
Roche, BMS, Pfizer, MSD, AbbVie,
Roche, Abbvie, Pfizer, UCB, BMS, MSD,
P. van Riel,
R. van Vollenhoven,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fixed-versus-on-flare-retreatment-with-rituximab-in-ra-results-from-the-cererra-collaboration/