Long-term Persistence with Rituximab in Patients with Rheumatoid Arthritis

Objectives
To investigate (i) the long term persistence of rituximab (RTX) in a large observational rheumatoid arthritis (RA) cohort, (ii) investigate persistence of RTX when used as a first or second line biologic-disease modifying anti-rheumatic drug (bDMARD) (iii) to characterise subsequent bDMARD treatment following RTX.
Methods
Patients with RA starting treatment with RTX (MabThera) between 2008 and 2011 were recruited into the British Society for Rheumatology Biologics Register for RA (BSRBR-RA). Duration of RTX treatment over the first four years after initiation was estimated via Kaplan-Meier estimates and the reason for discontinuation was ascertained. Subsequent bDMARD use following RTX discontinuation was characterised. Treatment survival in bDMARD-naïve (first line RTX use) and experienced (second line RTX use) cohorts was described.
Results
1,629 patients were recruited (1,371 bDMARD-experienced and 258 bDMARD-naïve). Sixty percent of the whole cohort remained on RTX after four years. Ineffectiveness (46%) and death (24%) were the most common reason for RTX discontinuation. RTX discontinuation was associated with rheumatoid factor negativity for the bDMARD-experienced cohort. Of those that discontinued RTX, 46% initiated treatment with another bDMARD, with tocilizumab being the most common.
Conclusions
This large study of patients initiating RTX treatment for severe RA found that 60% persisted with treatment after four years. This study also identified that RTX is tolerated well when used as a first or second line bDMARD.