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. CONCLUSION: In this observational cohort of patients who discontinued RTX, TCZ provided a better control of RA than ABA or TNFi.

BioRx si University Medical Center Ljubljana Slovenia and

DANBIO Center for Rheumatology and Spine Disease Glostrup Hospital Glostrup Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen

DANBIO Center for Rheumatology and Spine Disease Glostrup Hospital Glostrup Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Rheumatology University Hospital Basel Basel Switzerland

Institute of Rheumatology and Clinic of Rheumatology 1st Medical Faculty Charles University Prague Czech Republic

Rheumatology Research Unit Instituto de Medicina Molecular Lisbon Portugal on behalf of the Rheumatic Diseases Portugal Register

ROB FIN Department of Medicine Helsinki University Central Hospital Helsinki Finland

Unit for Clinical Therapy Research in Inflammatory Diseases The Karolinska Institute Stockholm Sweden

University Hospitals of Geneva SCQM Registry Geneva Switzerland

Rheumatology (Oxford). 2016 Feb;55(2):197-8. doi: 10.1093/rheumatology/kev375. PubMed

References provided by Crossref.org

EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis