title: Predictive factors of rituximab response in rheumatoid arthritis: results from a French university hospital.
abstract: OBJECTIVE
  To study the influence of several factors (rheumatoid factor [RF], anti-cyclic citrullinated peptide [anti-CCP], serum Ig level, and Epstein-Barr virus [EBV] load) on clinical response to rituximab (RTX) after 6 months in rheumatoid arthritis (RA) patients.
  
  
  METHODS
  Sixty-four patients receiving RTX (two 1-gm doses 2 weeks apart) for active RA were prospectively included. RF, anti-CCP, gamma globulin level, and EBV load were assessed prior to the first RTX cycle. Clinical responses were analyzed 6 months after RTX initiation using the European League Against Rheumatism criteria. Univariate and multivariate analyses were performed to identify factors associated with RTX response at 6 months.
  
  
  RESULTS
  The mean disease duration was 16.4 years and 46 patients (71.9%) had already received at least 1 anti-tumor necrosis factor agent prior to RTX. At 6 months, 46 patients (71.9%) had a good to moderate response to RTX. Anti-CCP positivity was associated with a good to moderate response (odds ratio [OR] 4, 95% confidence interval [95% CI] 1.04-15.5; P = 0.04). RF positivity (P = 0.26) and positive initial EBV load (P = 0.16) were not associated with a good to moderate response. Hyperimmunoglobulin was correlated with a poorer response to RTX than normal Ig levels (OR 0.04, 95% CI 0.005-0.28; P = 0.002).
  
  
  CONCLUSIONS
  Anti-CCP positivity was a predictor of good to moderate response to RTX in RA patients. On the other hand, high Ig levels were associated with a poorer outcome in contrast to previous findings. Further support from larger studies is necessary so as to optimize the management of the RA patients with high Ig levels.
authors.affiliation: CHU Gabriel Montpied, Clermont-Ferrand, France. mcouderc@chu-clermontferrand.fr
authors.forename: M
authors.initials: M
authors.lastname: Couderc
authors.forename: S
authors.initials: S
authors.lastname: Mathieu
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.forename: B
authors.initials: B
authors.lastname: Glace
authors.forename: M
authors.initials: M
authors.lastname: Soubrier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012217:Rheumatoid Factor / Q000097:blood*; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab; D002097:C-Reactive Protein; D012217:Rheumatoid Factor