AB0470 Efficacy of Very low Dose (100MG) Rituximab in Active Rheumatoid Arthritis Despite Combinations Dmards. (9th June 2015)

• Record Type: Journal Article
• Authors: Bavaliya, M.K.; Shenoy, P.
• Is Part Of: Annals of the rheumatic diseases. Volume 74(2015)Supplement 2
• Page Start: 1054
• Page End: 1054
• Publication Date: 2015-06-09
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-eular.1314
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Rituximab is an anti-CD20 antibody that represents a therapeutic alternative for the patients with rheumatoid arthritis. It has been proven that Rituximab at a dose of 2 gm is very effective in patients with DMARD and antiTNF failures. But the cost of this therapy is high and increases the economic burden. Limited data has shown that B cell is possible even with lower dosage to what is recommended. Objectives: 1) To assess B cell depletion with very low dose single dose of 100mg Rituximab 2) To assess improvement in disease activity (EULAR response) Methods: In this open label, prospective, observational study at tertiary care center sero positive RA patients who responded inadequately to combination of DMARDs were given single dose of 100 mg of Rituximab. B cell numbers in the peripheral blood was assessed by Flow cytometry and B cell depletion was defined as B cell numbers <0.01%. Efficacy was evaluated using B cell depletion after 2 weeks and disease activity score in 28 joints (DAS28) on monthly bases. Those patients who did not achieve B cell depletion and/or EULAR moderate response were given second dose of rituximab 500mg. Results: 15 patients (13 females and 2 males; mean age 47.7±13.95 years) were included in the study. Mean duration of the disease was 7.3±6.01 years. RF was positive in 14 out of 15 and Anti CCP antibody was positive in all patients. At baseline mean DAS score was 6.14±0.84 and mean CD 19% was 10.69±4.35%. After 2 weeks of Rituximab, B cell depletion was achieved in 12 patients (80%) and mean DAS28 was 2.72±0.57 at the end of 24 weeks. Two patients were given second dose of 500mg Rituximab after 8 weeks of first dose. All patients achieved EULAR good response at the end of 24 weeks. Conclusions: Early results from this study are very promising and show that low dose Rituximab is effective in treating RA patients inadequately responding to DMARDS. References: Edwards JC, Szczepanski L, Szechinski J et al. Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis.N Engl J Med. 2004 Jun 17;350(25):2572-81; Mease PJ, Revicki DA, Szechinski J et al.;Improved health-related quality of life for patients with active rheumatoid arthritis receiving rituximab: Results of the Dose-Ranging Assessment: International Clinical Evaluation of Rituximab in Rheumatoid Arthritis (DANCER) Trial. J Rheumatol. 2008 Jan;35(1):20-30. Epub 2007 Nov 15. Anolik JH, Barnard J, Cappione A et al. Rituximab improves peripheral B cell abnormalities in human systemic lupus erythematosus;Arthritis Rheum. 2004 Nov;50(11):3580-90; Bruzzese V. et al. Therapeutic effectiveness of minimal doses of rituximab in a patient with rheumatoid arthritis; Int J Immunopathol Pharmacol. 2011 Jan-Mar;24(1):265-7 Acknowledgements: We acknowledge flowcytometry lab incharge, chairman-ethics committee and medical director of institute. Disclosure of Interest: None declared