Factors Determining Retreatment Time Interval of Rituximab in Korean Patients With Rheumatoid Arthritis.

Ji-Won Kim,Ju-Yang Jung,Hyoun-Ah Kim,Kichul Shin,Chang-Hee Suh

doi:10.3389/fmed.2021.765535

Abstract

Unlike other biologic agents for rheumatoid arthritis (RA) that are administered at regular intervals even without flare, rituximab can be administered according to the timing of retreatment determined by the physician. Recently, there has been a tendency to prefer on-demand administration for disease flares rather than regular retreatment. We aimed to investigate the retreatment patterns of rituximab in patients with RA and to identify factors associated with extension of the time interval between retreatment courses. This study included RA patients on rituximab treatment who were enrolled in the Korean Rheumatology Biologics registry (KOBIO) or treated at Ajou University Hospital. Previous or current concomitant conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), corticosteroids, number of previous biologic agents, withdrawal, and time intervals of rituximab retreatment were collected. In case of treatment failure, the reasons such as lack of efficacy, adverse events, and others, were also identified. A total of 82 patients were enrolled. The mean follow-up period from the first cycle of rituximab was 46.1 months, and the mean interval between the retreatment courses was 16.3 months. The persistent rates of rituximab after 5 years was 72.4%. Concomitant use of at least two csDMARDs (β = 4.672; 95% CI: 0.089–9.255, p = 0.046) and concomitant use of corticosteroids (β = 7.602; 95% CI: 0.924–14.28, p = 0.026) were independent factors for extending the time interval between the retreatment courses. In conclusion, RA patients treated with rituximab in Korea show high persistence rates. Concomitant use of two or more csDMARDs and concomitant use of corticosteroids with rituximab are associating factors of extending the retreatment time interval. These findings should be considered when selecting rituximab as a treatment for patients with RA.

Highlights

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that primarily affects the synovial joints
This study aimed to investigate the patterns of use of rituximab in patients with rheumatoid arthritis (RA) in the real world, using the KOrean Rheumatology BIOlogics registry (KOBIO)
There was little change in the number of patients using csDMARDs during concomitant treatment at the time of the first rituximab cycle, but there was a difference in the number of medications

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that primarily affects the synovial joints. It is characterised by joint pain and functional disability that lead to reduced quality of life and a high socioeconomic burden [1]. B cells have emerged as therapeutic targets in treatment approaches involving direct depletion through monoclonal antibodies (mAb), inhibition of pro-inflammatory soluble factors or co-stimulatory molecules, and interruption of B cell activation or engagement of inhibitory checkpoint receptors [4]. Despite the development of B cell-targeted treatment, the first therapeutic anti-CD20 mAb remains a crucial modality, with a long history of successful clinical use. In RA, the only biological agent approved for specific B cell-targeted therapy is rituximab, a chimeric monoclonal antibody against the CD20 antigen of B cells [5]

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