[Rituximab (Mabthera)--treatment of rheumatoid arthritis patients with inadequate response to TNF inhibitors--when to change therapy?].
B cells play a critical role in the pathogenesis of rheumatoid arthritis. Recently, a number of biological agents that target B cells have been tested as therapies for these conditions. Of this group of agents, the first in clinical use has been rituximab, a chimeric monoclonal antibody that depletes B cells by binding to the CD20 cell-surface antigen. 25-40% of patients treated with a TNF inhibitor fail to achieve adequate response. A treatment response is inadequate if low disease activity or remission is not achieved. Treatment of patients with inadequate response to TNF inhibitors represents a challenge. What are the options? Switch to another anti-TNFalpha agent or initiate treatment with a biological agent with a different mechanism of action? In patients with persistent active disease despite anti-TNFalpha therapy, treatment with rituximab may be more effective than switching to another anti-TNFalpha.
Morović-Vergles
Jadranka
J
Zavod za klinicku imunologiju i reumatologiju, Klinika za unutarnje bolesti Klinicka bolnica "Dubrava", 10000 Zagreb.
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D000069283:Rituximab; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab