Effectiveness of Rituximab for the Treatment of Rheumatoid Arthritis in Patients with Prior Exposure to Anti-TNF: Results from the CORRONA Registry.
OBJECTIVE
To characterize the real-world effectiveness of rituximab (RTX) in patients with rheumatoid arthritis.


METHODS
Clinical effectiveness at 12 months was assessed in patients who were prescribed RTX based on the Clinical Disease Activity Index (CDAI). Change in CDAI was calculated (CDAI at 12 mos minus at initiation). Achievement of remission or low disease activity (LDA; CDAI ≤ 10) among those with moderate/high disease activity at the time of RTX initiation was compared based on prior anti-tumor necrosis factor agent (anti-TNF) use (1 vs ≥ 2) using logistic regression models.


RESULTS
Patients (n = 265) were followed for 12 months with a mean change in CDAI of -8.1 (95% CI -9.8 - -6.4). Of the 218 patients with moderate/high disease activity at baseline, patients with 1 prior anti-TNF (baseline CDAI 25.0) demonstrated a mean change in CDAI of -10.1 (95% CI -13.2 - -7.0); patients with ≥ 2 prior anti-TNF (baseline CDAI 30.0) demonstrated a mean change of -10.5 (95% CI -12.9 - -8.0). The unadjusted OR for achieving LDA/remission in patients with moderate/high disease activity at baseline exposed to ≥ 2 versus 1 prior anti-TNF was 0.40 (95% CI 0.22-0.73), which was robust to 4 different adjusted models (OR range 0.38-0.44).


CONCLUSIONS
A good clinical response was observed in all patients; however, patients previously treated with 1 anti-TNF, who had lower baseline CDAI and a greater opportunity for clinical improvement compared with patients previously treated with ≥ 2 anti-TNF, were more likely to achieve LDA/remission.
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine. Leslie.Harrold@umassmed.edu.
Leslie R
LR
Harrold
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
George W
GW
Reed
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
Ashwini
A
Shewade
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
Robert
R
Magner
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
Katherine C
KC
Saunders
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
Ani
A
John
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
Joel M
JM
Kremer
From the University of Massachusetts Medical School, Worcester; Corrona LLC, Southborough, Massachusetts; Genentech Inc., South San Francisco, California; Albany Medical College and The Center for Rheumatology, Albany; New York University (NYU) School of Medicine, New York, New York, USA.L.R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School; G.W. Reed, PhD, Department of Medicine, University of Massachusetts Medical School, and Corrona LLC; A. Shewade, MS, Genentech Inc.; R. Magner, MPH, Department of Medicine, University of Massachusetts Medical School; K.C. Saunders, MS, Corrona LLC; A. John, BSN, MPH, Genentech Inc.; J.M. Kremer, MD, Department of Rheumatology, Albany Medical College, and The Center for Rheumatology; J.D. Greenberg, MD, MPH, Department of Medicine, Division of Rheumatology, NYU School of Medicine.
Jeffrey D
JD
Greenberg
D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D019233:Retreatment; D000069283:Rituximab / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab
ANTIRHEUMATIC AGENTS; REGISTRIES; RHEUMATOID ARTHRITIS; RITUXIMAB