title: Long-term real-life experience with rituximab in adult Finnish patients with rheumatoid arthritis refractory or with contraindication to anti-tumor necrosis factor drugs.
abstract: OBJECTIVE
  The objective of this study was to evaluate the long-term safety and efficacy of repeated rituximab (RTX) infusions in the treatment of rheumatoid arthritis in daily clinical practice in Finland.
  
  
  METHODS
  Data were collected from the medical records of a total of 151 patients with rheumatoid arthritis treated with RTX and followed up for at least 12 months after the treatment onset. Change in the 28-joint Disease Activity Score (DAS28), European League Against Rheumatism response criteria and proportions of patients reaching disease remission (DAS28 < 2.6) or low disease activity (DAS28 < 3.2) were used to assess the clinical response.
  
  
  RESULTS
  Of the 151 patients 128 received 2 courses, 76 received 3 courses, and 42 received 4 courses of RTX. The mean time to retreatment for the first 4 courses varied between 11 and 13 months. Median DAS28 decreased from 5.4 (0.5-8.6) to 3.3 (0.6-6.6) after the first course. After the second treatment course, the DAS28 was 3.1 (range, 0.1-6.5). The median precourse baseline DAS28 before the second and third courses were 4.6 (range, 1.7-7.8) and 4.24 (range, 1.7-7.2), respectively. The number of previously failed tumor necrosis factor inhibitors did not predict response to RTX in this patient cohort with extensive use of previous disease-modifying antirheumatic drugs (median = 6).
  
  
  CONCLUSIONS
  The treatment as-needed regimen used in this study cohort led to delayed RTX retreatment and disease flare in a significant proportion of patients. A regular retreatment every 6 months, at least, after the first 2 treatment courses in patients who are not in remission could allow better control of disease activity.
authors.affiliation: From the *Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki; †Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere; ‡Roche Finland, Espoo; §Department of Medicine, North Karelia Central Hospital, Joensuu; ║Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna Regional Hospital, Hämeenlinna; ¶Department of Internal Medicine, Kanta-Häme Central Hospital, Riihimäki Regional Hospital, Riihimäki; #Department of Medicine, Division of Rheumatology, Turku University Hospital, Turku; and **Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Valleala
authors.forename: Markku
authors.initials: M
authors.lastname: Korpela
authors.forename: Tuija
authors.initials: T
authors.lastname: Hienonen-Kempas
authors.forename: Kai
authors.initials: K
authors.lastname: Immonen
authors.forename: Jukka
authors.initials: J
authors.lastname: Lähteenmäki
authors.forename: Tea
authors.initials: T
authors.lastname: Uusitalo
authors.forename: Riitta
authors.initials: R
authors.lastname: Komulainen
authors.forename: Timo
authors.initials: T
authors.lastname: Möttönen
authors.forename: Pekka
authors.initials: P
authors.lastname: Hannonen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products; D000075202:Contraindications; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab