RESEARCH ARTICLE
Sustained Remission After Combination Therapy with Rituximab and Etanercept in Two Patients with Rheumatoid Arthritis After TNF Failure: Case Report
Martin Feuchtenberger*, Christian Kneitz, Petra Roll, Stefan Kleinert, Hans-Peter Tony
Article Information
Identifiers and Pagination:
Year: 2009Volume: 3
First Page: 9
Last Page: 13
Publisher ID: TORJ-3-9
DOI: 10.2174/1874312900903010009
Article History:
Received Date: 31/12/2008Revision Received Date: 5/1/2009
Acceptance Date: 8/1/2009
Electronic publication date: 09/2/2009
Collection year: 2009
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Abstract
Objectives:
Approximately up to 40% of patients with rheumatoid arthritis (RA) fail to respond to tumor necrosis factor (TNF) inhibitors, lose response over time or are unable to tolerate treatment.
Materials and Methodology:
We report two female patients suffering from active, refractory rheumatoid arthritis despite TNF blocking agents who have been treated with rituximab added to ongoing therapy with etanercept.
Results:
Combination therapy was tolerated without any acute side effects. Both patients improved with a significant, long lasting reduction of disease activity (DAS28, CRP). Evaluation of the immunological parameters showed the expected B-cell depletion and a transient reduction of immunoglobulin-levels. One patient developed four serious infections requiring antibiotic treatment (1 pneumonia, 3 exacerbations of her pre-existing chronic bronchitis) within follow up of 45 months.
Conclusion:
Combination therapy of rituximab and etanercept lead to a significant improvement of clinical disease activity and inflammatory parameters in two RA patients refractory to anti-TNF treatment.
