Rituximab Can Induce Remission in a Patient with Ankylosing Spondylitis Who Failed Anti-TNF-α Agent.
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory disease that predominantly affects the axial skeleton. The ability of anti-TNF-α agents to reduce disease activity in patients with axial spondyloarthritis (axSpA), including AS, has been demonstrated in multiple randomized trials and several meta-analyses. Reports on the efficacy of rituximab in treatment of AS have described good results. We report on a patient with AS who failed anti-TNF-α therapy but showed good clinical improvement with rituximab therapy. CASE REPORT A 38-year-old male patient was diagnosed with AS and showed poor response to sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs). Infliximab was initiated with marked improvement as per the Bath ankylosing spondylitis disease activity index (BASDAI). Due to disease flare, the patient was switched to etanercept. He subsequently acquired papillary thyroid cancer and etanercept was discontinued. He underwent a total thyroidectomy followed by radioiodine therapy. For his ongoing active disease, NSAIDs and sulfasalazine were resumed with a lack of response (BASDAI=7.1). Rituximab was started and resulted in significant improvement (BASDAI=2.3). CONCLUSIONS Rituximab can be a potential target therapy for patients who start to lose response to TNF-inhibitors or for those who develop solid malignancies. Further placebo-controlled studies are required.
Department of Internal Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.
Fahmi
F
AlDhaheri
Department of Internal Medicine, Medical College, Umm-Al Qura University, Makkah, Saudi Arabia.
Talal
T
Almteri
Department of Internal Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.
Naji
N
Dwid
Department of Internal Medicine, Medical College, Umm-Al Qura University, Makkah, Saudi Arabia.
Ahd
A
Majdali
Internal medicine department, Dr.soliman Fakeeh hospital, Makkah, Saudi Arabia.
Nahed
N
Janoudi
Department of Internal Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.|Department of Internal Medicine, Medical College, Umm-Al Qura University, Makkah, Saudi Arabia.|Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm-Al Qura University, Makkah, Saudi Arabia.
Hani
H
Almoallim
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012074:Remission Induction / Q000379:methods; D000069283:Rituximab / Q000627:therapeutic use*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab