Rituximab: new indication. In rheumatoid arthritis: for a few patients, with close monitoring.
(1) Methotrexate is often used as a first-line treatment for severe and worsening rheumatoid arthritis. TNF alpha antagonists (etanercept, infliximab and adalimumab) are second-line options. (2) Rituximab, a monoclonal antibody first used to treat lymphoma, is now also approved for the treatment of rheumatoid arthritis when at least one TNF alpha antagonist has failed. (3) There are three available comparative trials including about 1150 rheumatoid arthritis patients. The results indicate that rituximab is no more effective than methotrexate; a combination of rituximab + methotrexate is more effective than methotrexate alone (although only about half the patients meet the ACR 20% response criterion); and adding a steroid fails to improve effectiveness. (4) The adverse effect profile of rituximab in arthritis seems similar to that observed in lymphoma. In the short term, the main adverse effects are infusion hypersensitivity reactions, which are more frequent during the first infusion and can be partly prevented by premedication with a steroid. The other known risks are mainly infectious and cardiovascular. Follow-up is too short to rule out a possible increase in the risk of cancer. Gastrointestinal perforations have occurred in some lymphoma patients treated with rituximab. (5) In practice, when standard treatment fails, adding rituximab to methotrexate can be beneficial but requires close patient monitoring.
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005060:Europe; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D008727:Methotrexate