title: Rituximab therapy in patients with rheumatoid arthritis refractory or with contraindication to anti-tumour necrosis factor drugs: real-life experience in Finnish patients.
abstract: OBJECTIVE
  To describe the effects of rituximab therapy in patients with rheumatoid arthritis (RA) in routine clinical practice in Finland.
  
  
  METHODS
  Data were collected retrospectively from patient records in five rheumatology clinics in Finland. All RA patients treated during 2005-2008 (n = 81) were included. Information on disease-modifying anti-rheumatic drugs (DMARDs), DMARD combinations, and biologics prior to rituximab use was collected as well as treatment responses after initiating rituximab therapy. The Disease Activity Score using 28 joint counts (DAS28) was used to determine disease activity and European League Against Rheumatism (EULAR) responses.
  
  
  RESULTS
  Mean disease duration was 14 (range 0-47) years and the median number of prior DMARDs and biologics used were 7 (1-12) and 2 (0-4), respectively. Efficacy analysis was performed on 57 patients with available DAS28 data at treatment onset and follow-up visits. Median DAS28 declined from 6.07 (3.19-7.70) to 3.99 (1.53-6.55) by the first rituximab treatment course. Altogether 77% of the patients achieved a EULAR response, 26% with a good response including 18% with remission. Furthermore, the patients treated concomitantly with DMARDs other than methotrexate (MTX) achieved a EULAR response slightly more often than the patients on MTX (85% vs. 70%) only. A second course of rituximab was given to 48% of the patients on an average of 9 months after initial therapy, with the median DAS28 score declining further to 3.49 (0.1-5.74). Safety and tolerability assessment of the 81 patients indicates rituximab to be well tolerated.
  
  
  CONCLUSIONS
  Rituximab can effectively control disease activity in patients with active disease and poor response to previous therapies, in combination with MTX but also with other DMARDs.
authors: Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Helsinki, Finland. heikki.valleala@hus.fi
authors: H
authors: H
authors: Valleala
authors: M
authors: M
authors: Korpela
authors: T
authors: T
authors: Möttönen
authors: T
authors: T
authors: Hienonen-Kempas
authors: M
authors: M
authors: Kauppi
authors: P
authors: P
authors: Hannonen
authors: M
authors: M
authors: Leirisalo-Repo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016009:Chi-Square Distribution; D000075202:Contraindications; D004359:Drug Therapy, Combination; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008499:Medical Records; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab; D011239:Prednisolone; D008727:Methotrexate