title: Sustained Remission After Combination Therapy with Rituximab and Etanercept in Two Patients with Rheumatoid Arthritis After TNF Failure: Case Report.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Würzburg, Dept. of Medicine II, Rheumatology and Clinical Immunology, Germany; Department of Medicine II, Klinikum Südstadt Rostock, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Feuchtenberger
authors.forename: Christian
authors.initials: C
authors.lastname: Kneitz
authors.forename: Petra
authors.initials: P
authors.lastname: Roll
authors.forename: Stefan
authors.initials: S
authors.lastname: Kleinert
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Tony