title: Rituximab (RTX) as an Alternative to TNF-Alpha Antagonists in Patients with Rheumatoid Arthritis and High Risk of Severe Infections: A Systematic Analysis of the Experience in One Center.
abstract: OBJECTIVE
  The use of TNF-alpha antagonists may be associated with an increased rate of infections in risk populations of patients with RA. Our hypothesis was that in patients with a high risk of infection Rituximab (RTX) could be a safer alternative.
  
  
  METHODS
  We analyzed the outcome of RA patients who received RTX instead of TNF-alpha antagonist because of a history of serious infections or frequent infectious events. All patients in a given time period were included in the retrospective analysis.
  
  
  RESULTS
  32 patients were identified according to the above criteria and followedup for a mean period of 16 ± 8 months (range 6 - 36) during treatment with RTX. Only one patient was lost to follow-up. Sixteen patients were anti-TNF-naïve and in the remaining patients the TNF-alpha antagonist was stopped due to infectious complications before starting RTX. RTX was combined with a disease modifying drug in 22 (69%) of the cases. Altogether 4 severe infections occurred (9.5/100 patient years), mainly within the first year of treatment with RTX. Two patients suffered from pneumonia, 1 from a postoperative wound infection, 1 from an ear abscess and bacterial bronchitis. None of our patients with a previous history of bacterial infections of soft tissue, bacterial arthritis or osteomyelitis (n=9) developed recurrent infection. No relapse of a previously diagnosed tuberculosis (n=9) was seen.
  
  
  CONCLUSIONS
  In this particular high risk population of RA patients, treatment with RTX seems to be an alternative to TNF-alpha-antagonist and has a relatively low rate of recurrent infection.
authors.affiliation: ACURA Center for Rheumatic Diseases, Baden-Baden, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Xanthouli
authors.forename: S
authors.initials: S
authors.lastname: Sailer
authors.forename: C
authors.initials: C
authors.lastname: Fiehn