Rituxan Treatment in Rheumatoid Arthritis
by Dr. C.H. Weaver M.D. updated 6/2019
Rituxan is a drug that is used to treat RA, non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, and other conditions. It targets a type of white blood cell known as a B-cell. B-cells are believed to contribute to the symptoms and joint damage of RA.
Rituxan is effectively used in the management of RA, appears safe and well tolerated and appears to be particularly effective in RA associated lung disease.
To evaluate the safety of long-term use of Rituxan for RA, researchers collected information about more than 3,000 patients who had been treated with a combination of Rituxan and methotrexate for up to 9.5 years. Information was also collected about roughly 800 patients who had been treated with a placebo plus methotrexate.
- The rate of serious side effects remained fairly stable over time among patients treated with Rituxan. Furthermore, the rate of serious infections was similar among patients treated with Rituxan plus methotrexate (3.94 events per 100 patients per year) and patients treated with placebo plus methotrexate (3.79 events per 100 patients per year).
- Rates of heart attack and stroke were similar to rates among RA patients in the general population.
These results suggest that frequency of side effects remains generally stable over time among patients who received prolonged treatment with Rituxan. Long-term follow-up did not identify new or increasing risks of treatment.
Rituxan is Non-Inferior to TNF Inhibitors in Early RA Patients
The results of a clinical study have demonstrated that both Rituxan® (rituximab) and tumour necrosis factor inhibitors (TNFi) are equally and highly effective for the treatment of early, active rheumatoid arthritis (RA).
Currently, most physicians use a TNFi as initial biologic treatment following failure of methotrexate. Rituxan is commonly used in the management of RA later in the disease course and the current study examined whether or not Rituxan would be clinically non-inferior and less expensive compared to a TNFi.
A 12 month clinical trial directly compared 295 active RA patients, enrolled over a 4 year period. Patients received either Rituxan or Humira® (adalimumab), a widely utilized TNFi. The 12 month changes in disease activity score were similar for both treatments, however serious adverse events were slightly higher in the Rituxan group (n=37) compared to patients receiving TNFi (n=26).
Rituxan was significantly less expensive than the TNFi and the results of the study suggest that in addition to being less costly, Rituxan offers patients with RA another treatment option early in their disease course. When considering the differences among RA patients, having another option provided both patients and their physicians with increased flexibility in their management.
- van Vollenhoven RF, Emery P, Bingham CO 3rd et al. Long-term safety of rituximab in rheumatoid arthritis: 9.5-year follow-up of the global clinical trial programme with a focus on adverse events of interest in RA patients. Annals of the Rheumatic Diseases. 2013 Sep 1;72(9):1496-502.
- Porter D, van Melckebeke J, Dale J, Messow C, et al. Tumour necrosis factor inhibition versus rituximab for patients with rheumatoid arthritis who require biological treatment (ORBIT): an open-label, randomised controlled, non-inferiority, trial. The Lancet. Volume 388, No. 10041, p239–247, 16 July 2016.