Predictive Factors of Rituximab Response in Rheumatoid Arthritis: Results From a French University Hospital
Article first published online: 28 MAR 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 4, pages 648–652, April 2013
How to Cite
Couderc, M., Mathieu, S., Pereira, B., Glace, B. and Soubrier, M. (2013), Predictive Factors of Rituximab Response in Rheumatoid Arthritis: Results From a French University Hospital. Arthritis Care Res, 65: 648–652. doi: 10.1002/acr.21865
- Issue published online: 28 MAR 2013
- Article first published online: 28 MAR 2013
- Accepted manuscript online: 8 OCT 2012 12:13PM EST
- Manuscript Accepted: 25 SEP 2012
- Manuscript Received: 18 APR 2012
To study the influence of several factors (rheumatoid factor [RF], anti–cyclic citrullinated peptide [anti-CCP], serum Ig level, and Epstein-Barr virus [EBV] load) on clinical response to rituximab (RTX) after 6 months in rheumatoid arthritis (RA) patients.
Sixty-four patients receiving RTX (two 1-gm doses 2 weeks apart) for active RA were prospectively included. RF, anti-CCP, gamma globulin level, and EBV load were assessed prior to the first RTX cycle. Clinical responses were analyzed 6 months after RTX initiation using the European League Against Rheumatism criteria. Univariate and multivariate analyses were performed to identify factors associated with RTX response at 6 months.
The mean disease duration was 16.4 years and 46 patients (71.9%) had already received at least 1 anti–tumor necrosis factor agent prior to RTX. At 6 months, 46 patients (71.9%) had a good to moderate response to RTX. Anti-CCP positivity was associated with a good to moderate response (odds ratio [OR] 4, 95% confidence interval [95% CI] 1.04–15.5; P = 0.04). RF positivity (P = 0.26) and positive initial EBV load (P = 0.16) were not associated with a good to moderate response. Hyperimmunoglobulin was correlated with a poorer response to RTX than normal Ig levels (OR 0.04, 95% CI 0.005–0.28; P = 0.002).
Anti-CCP positivity was a predictor of good to moderate response to RTX in RA patients. On the other hand, high Ig levels were associated with a poorer outcome in contrast to previous findings. Further support from larger studies is necessary so as to optimize the management of the RA patients with high Ig levels.