title: [Consensus on the Use of Rituximab in Rheumatoid Arthritis. A document with evidence-based recommendations. Grupo de Expertos en Rituximab. ].
abstract: BACKGROUND
  Rituximab has been employed successfully for the treatment of Rheumatoid Arthritis (RA). However, its particular mechanism of action, as well as a lack of concrete guidelines for its management have generated doubts on its use.
  
  
  OBJECTIVE
  To establish recommendations that facilitates the use of rituximab in common clinical practice.
  
  
  METHODS
  In a first Delphi round, 9 expert rheumatologists got together to develop questions on those subjects generating most doubts on the efficacy and safety of the drug. These were adapted to perform a systematic review of the evidence, which was presented in a second meeting. Nominal groups were formed to respond to each question and give a recommendation. These recommendations were presented in a second Delphi round to a larger group of experts in rheumatology. Once again recommendations were discussed, modified and voted upon. Once approved, a vote on the degree of agreement for each recommendation was carried out.
  
  
  RESULTS
  17 recommendations were established, 10 regarding efficacy and 7 safety. All of the efficacy recommendations except 3 presented a good or moderate degree of evidence. Among the safety recommendations, 3 had a good or moderate degree of evidence while in the rest it was indirect, scarce or non-existent and a product of expert recommendation. The degree of agreement between experts was elevated for most of the recommendations.
  
  
  CONCLUSIONS
  These recommendations attempt to clear doubts on the use of rituximab and establish guidelines for its use in daily practice. Efficacy recommendations have a high degree of evidence, allowing the clinician to be guided in therapeutic decisions. Safety recommendations have a lower degree of evidence.
authors.affiliation: Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. emartinmola.hulp@salud.madrid.org
authors.forename: Emilio
authors.initials: E
authors.lastname: Martín Mola
authors.forename: Blanca
authors.initials: B
authors.lastname: Hernández
authors.forename: Miriam
authors.initials: M
authors.lastname: García-Arias
authors.forename: José María
authors.initials: JM
authors.lastname: Alvaro-Gracia
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
authors.forename: Juan Gómez
authors.initials: JG
authors.lastname: Reino
authors.forename: José L
authors.initials: JL
authors.lastname: Marenco de la Fuente
authors.forename: Víctor
authors.initials: V
authors.lastname: Martínez-Taboada
authors.forename: José Andrés Román
authors.initials: JA
authors.lastname: Ivorra
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000276:immunology; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D002986:Clinical Trials as Topic; D003697:Delphi Technique; D004305:Dose-Response Relationship, Drug; D004306:Dose-Response Relationship, Immunologic; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000209:etiology; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000096:biosynthesis; D007075:Immunoglobulin M / Q000096:biosynthesis; D017093:Liver Failure / Q000209:etiology; D017563:Lung Diseases, Interstitial / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000209:etiology; D000069283:Rituximab; D014611:Vaccination
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000069283:Rituximab