title: Eficiency of different doses of rituximab in rheumatoid arthritis.
abstract: OBJECTIVE
  Evaluate the effectiveness, cost and safety of rituximab in patients with rheumatoid arthritis (RA) depending on the dose used.
  
  
  METHODS
  Retrospective observational study conducted on 52 patients with RA treated with at least one dose of rituximab for 135.3 patient-years were included. Three treatment groups were obtained: (G1) First course and following two 1g infusions separated by 15 days; (G2) First course 2 infusions of 1g followed by 2 infusions of 500mg; (G3) First course and followed by 2 infusions of 500mg separated by 15 days. Re-treatments were administered on-demand according to the clinical activity. The retention time (Log-Rank), retreats and adverse events rates (incidence rate ratio) and treatment costs per patient-month of rituximab were analysed by groups.
  
  
  RESULTS
  Group 2 showed a better cost-effectiveness ratio than group 1, as it was associated with a longer retention of rituximab (mean [95% CI] 65.7 [60.8 to 70.7] months vs 33.5 [22.7 to 44.3]; P<.001) and a lower rate of severe adverse events with only a slight increase in the rate of retreatment (courses/patient-year [95% CI] 1.66 [1.39 to 1.93] vs. 1.01 [0.69 to 1.34]; P=.005), and in the costs (median/patient-month, €484.89 vs. €473.45). Although group 3 was €41.20/patient-month cheaper than group 2, it was associated with a higher rate of re-treatments and shorter retention of rituximab (P<.001).
  
  
  CONCLUSIONS
  The use of full-dose rituximab at onset, followed by reduced doses in successive courses administered on-demand retreatment may be the most cost-effective option.
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Natalia
authors.initials: N
authors.lastname: Mena-Vázquez
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Sara
authors.initials: S
authors.lastname: Manrique-Arija
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ureña-Garnica
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Romero-Barco
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Francisco G
authors.initials: FG
authors.lastname: Jiménez-Núñez
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: Virginia
authors.initials: V
authors.lastname: Coret
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Irigoyen-Oyarzábal
authors.affiliation: Unidad de Gestión Clínica de Reumatología, Instituto de investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España. Electronic address: afernandezn@uma.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Nebro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D000069283:Rituximab
keywords: Adult; Adulto; Agentes antirreumáticos/administración y dosis; Agentes antirreumáticos/efectos adversos; Agentes antirreumáticos/uso terapéutico; Antibodies, monoclonal, murine-derived; Antibodies, monoclonal/administration and dosage; Antibodies, monoclonal/adverse effects; Antibodies, monoclonal/therapeutic use; Anticuerpos, monoclonal, derivado-murino; Anticuerpos, monoclonal/administración y dosis; Anticuerpos, monoclonal/efectos adversos; Anticuerpos, monoclonal/uso terapéutico; Antirheumatic agents/administration and dosage; Antirheumatic agents/adverse effects; Antirheumatic agents/therapeutic use; Arthritis, rheumatoid/drug therapy; Arthritis, rheumatoid/immunology; Artritis, reumatoide/inmunología; Artritis, reumatoide/terapia farmacológica; Dose-response relationship, drug; Drug administration schedule; Humanos; Humans; Pauta administración fármaco; Relación dosis-respuesta, fármaco; Rituximab; Tratamiento desenlace; Treatment outcome