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Abstract Number: 617

Long-Term Outcome of Rituximab in Rheumatoid Arthritis: Real World Experience

Candice Low1, Richard Conway1, Francis Young2, Eamonn S. Molloy3, Anne Barbara Mongey3, Oliver FitzGerald4, Anthony G. Wilson5, Ursula Fearon6 and Douglas J. Veale1, 1Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland, 2Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, University College Dublin, Dublin 4, Ireland, 3Saint Vincent's University Hospital, Dublin 4, Ireland, 4Department of Rheumatology, St Vincent's University Hospital and Conway Institute, University College Dublin, Ireland, Dublin, Ireland, 5UCD School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland, 6Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: rheumatoid arthritis (RA) and rituximab

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Session Information

Date: Sunday, October 21, 2018

Session Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Rituximab is an effective treatment for rheumatoid arthritis (RA). Data on long-term outcomes following rituximab treatment are limited. The aim of this study was to evaluate the long-term efficacy of, and identify predictors of response to, rituximab in our centre.

Methods:

We conducted an observational study of RA patients treated with rituximab from 2003-2016. Demographic and clinical characteristics, including response to treatment, were assessed with tender joint count, swollen joint count, erythrocyte sedimentation rate, and C-reactive protein. Arthroscopy was performed in patients where clinically indicated. Univariate and multivariable logistic regression models were established to evaluate baseline predictors of treatment response. Remission was defined as DAS28-CRP <2.6 or meeting the 2011 ACR/EULAR remission criteria.

Results:

114 RA patients were treated with rituximab. Mean (range) age was 62 (49-75) years. 73% were female, 85% were rheumatoid factor (RF)+, 64% anti-citrullinated protein antibody (ACPA)+, 59% RF+ and ACPA+. Median (IQR) disease duration was 13.5 (7,24.3) years and number of prior conventional synthetic DMARDs (csDMARDs) was 1 (0,2) and biologic DMARDs was 1 (0,2). Baseline characteristics of patients are shown in Table 1. 34 were receiving rituximab monotherapy, 80 were receiving combination therapy with a csDMARD. At last follow-up median (IQR) duration of rituximab treatment was 3.1 (1.8, 6.1) years. 68 (60%) patients maintained remission, 14 (12%) were primary non-responders (7% RF-, 50% ACPA-, 7% RF-ACPA-), 25 (22%) secondary non-responders (24% RF-, 40% ACPA-, 12% RF-ACPA-), and 7 (6%) stopped rituximab due to adverse events (3 hypersensitivity reactions, 2 recurrent LRTIs, 1 neutropenia, 1 severe herpes zoster). Of the 68 patients in remission, 26 (38%) were on rituximab monotherapy and 42 (62%) were receiving combination therapy with a csDMARD. Of the 39 biologic naïve patients, 24 (62%) were in remission and 15 (38%) were not; rituximab achieved equally good outcomes in patients who had previously failed a biologic. No significant baseline predictors of treatment response were identified using logistic regression modelling. In the 44 patients who had an arthroscopy, baseline ESR (p=0.312), CRP (p=0.590), patient global assessment (p=0.934), DAS28-CRP (p=1), TJC (p=0.750), SJC (p=0.848), macroscopic synovitis (p=0.490), macroscopic vascularity (p=0.936), and histologic inflammation (p=0.146) did not predict response to rituximab.

Conclusion:

Rituximab is an effective long-term treatment, with 60% remission, for many of our RA patients, including those who have previously failed a biologic. In this cohort, no baseline demographic, clinical, or serological characteristics accurately predict response to rituximab.

Table 1: Baseline characteristics of 114 rituximab treated patients

N=114

Age, years, mean (+-SD)

62 (+-13)

Female, n (%)

83 (73)

Disease duration, years, median (IQR)

13.5 (7, 24.3)

Previous csDMARDs, median (IQR)

1 (0, 2)

Previous bDMARDs, median (IQR)

1 (0, 2)

Serology, n (%)

RF+

ACPA+

RF+ACPA+

RF-ACPA-

97 (85%)

73 (64%)

67 (59%)

13 (11%)


Disclosure: C. Low, None; R. Conway, None; F. Young, None; E. S. Molloy, None; A. B. Mongey, None; O. FitzGerald, None; A. G. Wilson, None; U. Fearon, None; D. J. Veale, None.

To cite this abstract in AMA style:

Low C, Conway R, Young F, Molloy ES, Mongey AB, FitzGerald O, Wilson AG, Fearon U, Veale DJ. Long-Term Outcome of Rituximab in Rheumatoid Arthritis: Real World Experience [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/long-term-outcome-of-rituximab-in-rheumatoid-arthritis-real-world-experience/. Accessed August 12, 2022.
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