Rituximab (RTX) as an Alternative to TNF-Alpha Antagonists in Patients with Rheumatoid Arthritis and High Risk of Severe Infections: A Systematic Analysis of the Experience in One Center
P Xanthouli, S Sailer, C Fiehn*
Identifiers and Pagination:Year: 2012
First Page: 286
Last Page: 289
Publisher Id: TORJ-6-286
Article History:Received Date: 13/6/2012
Revision Received Date: 13/7/2012
Acceptance Date: 20/7/2012
Electronic publication date: 7/9/2012
Collection year: 2012
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.
The use of TNF-alpha antagonists may be associated with an increased rate of infections in risk populations of patients with RA. Our hypothesis was that in patients with a high risk of infection Rituximab (RTX) could be a safer alternative.
We analyzed the outcome of RA patients who received RTX instead of TNF-alpha antagonist because of a history of serious infections or frequent infectious events. All patients in a given time period were included in the retrospective analysis.
32 patients were identified according to the above criteria and followedup for a mean period of 16 ± 8 months (range 6 – 36) during treatment with RTX. Only one patient was lost to follow-up. Sixteen patients were anti-TNF-naïve and in the remaining patients the TNF-alpha antagonist was stopped due to infectious complications before starting RTX. RTX was combined with a disease modifying drug in 22 (69%) of the cases. Altogether 4 severe infections occurred (9.5/100 patient years), mainly within the first year of treatment with RTX. Two patients suffered from pneumonia, 1 from a postoperative wound infection, 1 from an ear abscess and bacterial bronchitis. None of our patients with a previous history of bacterial infections of soft tissue, bacterial arthritis or osteomyelitis (n=9) developed recurrent infection. No relapse of a previously diagnosed tuberculosis (n=9) was seen.
In this particular high risk population of RA patients, treatment with RTX seems to be an alternative to TNF-alpha-antagonist and has a relatively low rate of recurrent infection.