title: Rituximab done: what's next in rheumatoid arthritis? A European observational longitudinal study assessing the effectiveness of biologics after rituximab treatment in rheumatoid arthritis.
abstract: OBJECTIVE
  To compare the effectiveness of biologics after rituximab (RTX) treatment in RA.
  
  
  METHODS
  The effectiveness of TNF-α inhibitors (TNFi), abatacept (ABA) or tocilizumab (TCZ) was examined in patients previously treated with RTX using clinical data collected in the Collaborative Registries for the Evaluation of Rituximab in RA Collaborative registry. Patients had stopped RTX 6 months or less prior to the new biologic and had a baseline visit within 21 days of starting the new biologic.
  
  
  RESULTS
  Two hundred and sixty-five patients were analysed after 6 months of treatment. Patients on TCZ (n = 86) had a greater decline of DAS28-ESR and clinical disease activity index than patients on TNFi (n = 89) or ABA (n = 90). This effect was also seen after adjusting for baseline prednisone use and the number of previous biologics. The mean DAS28-ESR scores in patients on TCZ were 1.0 (95% CI: 0.2, 1.7) and 1.8 (95% CI: 1.0, 2.5) points lower than in patients on TNFi or ABA, respectively. In patients on TCZ, the clinical disease activity index was 9.4 (95% CI: 1.7, 16.1) and 8.1 (95% CI: 0.9, 15.3) points lower than on TNFi and ABA, respectively. Patients on TCZ more frequently had good EULAR responses than patients on TNFi or ABA (66 vs 31 vs 14%, P < 0.001). The HAQ disability index improved in all treatment groups (P < 0.001), but did not differ between biologics, as did drug retention rates. The reasons for discontinuation of RTX and the number of previous biologics had no influence on outcomes.
  
  
  CONCLUSIONS
  In this observational cohort of patients who discontinued RTX, TCZ provided a better control of RA than ABA or TNFi.
authors: Department of Rheumatology, University Hospital Basel, Basel, Switzerland, ulrich.walker@usb.ch.
authors: Ulrich A
authors: UA
authors: Walker
authors: Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
authors: Veronika K
authors: VK
authors: Jaeger
authors: Unit for Clinical Therapy Research in Inflammatory Diseases, The Karolinska Institute, Stockholm, Sweden.
authors: Katerina
authors: K
authors: Chatzidionysiou
authors: DANBIO, Center for Rheumatology and Spine Disease, Glostrup Hospital, Glostrup, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen.
authors: Merete L
authors: ML
authors: Hetland
authors: DANBIO, Center for Rheumatology and Spine Disease, Glostrup Hospital, Glostrup, Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
authors: Ellen-Margrethe
authors: EM
authors: Hauge
authors: Institute of Rheumatology and Clinic of Rheumatology 1st Medical Faculty Charles University, Prague, Czech Republic.
authors: Karel
authors: K
authors: Pavelka
authors: ROB-FIN, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors: Dan C
authors: DC
authors: Nordström
authors: Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal on behalf of the Rheumatic Diseases Portugal Register.
authors: Helena
authors: H
authors: Canhão
authors: BioRx.si, University Medical Center, Ljubljana, Slovenia and.
authors: Matija
authors: M
authors: Tomšič
authors: Unit for Clinical Therapy Research in Inflammatory Diseases, The Karolinska Institute, Stockholm, Sweden.
authors: Ronald
authors: R
authors: van Vollenhoven
authors: University Hospitals of Geneva/SCQM Registry, Geneva, Switzerland.
authors: Cem
authors: C
authors: Gabay
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D000069283:Rituximab / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D000069283:Rituximab
keywords: biologic drugs; disease activity; rheumatoid arthritis; rituximab; tocilizumab