Background/Purpose: Recent trial data from Mariette et al. investigating a single-dose 1g rituximab regimen as opposed to a double-dose 1g rituximab regimen in patients with RA and a good or moderate EULAR response to an initial double-dose rituximab regimen, demonstrated non-inferiority in terms of a DAS-28 response [1]. There may be potential benefits of a lower dose rituximab regimen to patient safety and care, such as reducing the risk of hypogammaglobulinaemia and serious infection [2] and a reduced delay in repeat treatment time. There are also potential cost savings and health economic implications to a lower dose rituximab regimen. The aims of this audit were to assess whether our department was prescribing rituximab in accordance to National Institute of Clinical Excellence (NICE) guidance [3] and to evaluate the potential cost savings that could be made in a large cohort of patients receiving repeat rituximab treatment for RA.

Methods: Notes were reviewed from a random sample of 50 patients on our electronic biologic database receiving rituximab for RA at the Freeman Hospital, Newcastle-Upon-Tyne between 2013 and 2016. Data on prior biologic exposure, frequency of rituximab infusions and EULAR response to rituximab was recorded.

Results: The electronic database identified 210 patients who were receiving rituximab at least annually. Complete data was available from to audit from 44/50 of the random sample. 37/44 patients had received a prior anti-TNF therapy and 6 patients had documented reasons for not having received anti-TNF therapy (ie history of malignancy or interstitial lung disease). 1 patient had been started on rituximab pre-dating our electronic records. 36/40 (82%) patients had a good or moderate response to rituximab and in the other 8 patients, rituximab was either stopped or were under review pending a management decision. No-one had rituximab infusions more frequently than 6 monthly. This data was in keeping with NICE guidance [3]. In order to estimate the potential cost savings to our department by using a single-dose 1g rituximab regimen rather than a standard double-dose regimen, we calculated the mean number of treatments given to our cohort of patients with RA as 1.66 1g infusions per year. If this infusion number was halved to 0.83 1g infusions per year, the estimated annual saving to our department would be £435,000 (this is based on 210 patients receiving repeat rituximab infusions in 2015/2016 and the price per 1g rituximab infusion plus infusion costs of £2,495).

Conclusion: Current practice in the Freeman Hospital, Newcastle-Upon-Tyne is adherent to NICE guidance [3]. Using a single-dose repeat rituximab regimen rather than a double-dose repeat rituximab regimen has been demonstrated to have non-inferior clincial outcome data [1] and has potential long-term safety benefits to patients. In our trust, which prescribes a large amount of rituximab for RA, we could potentially save around £435,000 per annum by switching to a single-dose rituximab regimen. [1] Mariette X, Rouanet S et al. Evaluation of low-dose rituximab for the retreatment of patients with active rheumatoid arthritis: a non-inferiority randomised controlled. Ann Rheum Dis. 2014;73:1508–14. [2] —Gottenberg JE, Ravaud P et al. Low serum IgG level after rituximab is associated with an increased risk of serious infections in rheumatoid arthritis: data of the AIR Registry. Arthritis Rheum 2011;63(Suppl):S641. [3] NICE TA195. Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor. 2010. https://www.nice.org.uk/guidance/ta195

ACR Meeting Abstracts - https://acrabstracts.org/abstract/single-1g-infusion-vs-double-1g-infusion-of-rituximab-in-rheumatoid-arthritis-in-a-large-teaching-hospital-potential-clinical-benefits-and-financial-savings/