Gutierrez-Gonzalez Luis Arturo, Gudiño Marco Antonio Rivera, Ceija Ibell Oropeza, Leonet Marialina Marin, Noguera Zair Tovar
Hospital Universitario de Caracas, HUC-UCV, Venezuela.
Open Rheumatol J. 2013 Oct 18;7:81-6. doi: 10.2174/1874312920130913004. eCollection 2013.
Our aim was to compare an AntiCD20 therapy (rituximab) for rheumatoid arthritis in two patient populations (Group 1), anti-TNFα naïve patients and inadequate responders to Anti-TNFα therapy (Group 2).
We analyzed the efficacy of the drug Rituximab (RTX) in RA patients who failed methotrexate (MTX) or had a relative or absolute contraindication to receive anti-TNFα therapy.
25 patients were identified according to the above criteria and followed up for a mean period of 6 months. Thirteen patients were biologic naïve and twelve patients had already failed anti-TNFα therapy. Group 1 used 2> DMARDs (32% vs 20%, p<0.005), group 2 had more years of disease progression (5±1.89 v s4.10±3.92, p<0.001). The remission as measured by the DAS28 reached faster in group 1 (1.25±0.12 vs 2.15±1.64, p<0,001). Severe infections especially by herpes viruses were more frequent in group 2.
Comparing clinical improvement in both groups the decrease of acute phase reactants and the clinical remission measured by DAS28 was reached in both groups, however it was reached more belatedly in group 2 (at 6 months), this is due to the fact that they have more years of the disease evolution and a higher HAQ.
我们的目的是比较抗CD20疗法（利妥昔单抗）在两类患者群体（第1组）中治疗类风湿性关节炎的效果，这两类群体分别是：未使用过抗TNFα疗法的患者以及对抗TNFα疗法反应不足的患者（第2组）。
我们分析了利妥昔单抗（RTX）在对甲氨蝶呤（MTX）治疗无效或有相对或绝对禁忌证而不能接受抗TNFα治疗的类风湿性关节炎患者中的疗效。
根据上述标准确定了25例患者，并进行了平均为期6个月的随访。13例患者未使用过生物制剂，12例患者对抗TNFα疗法已经无效。第1组使用超过2种改善病情抗风湿药的患者更多（32%对20%，p<0.005），第2组疾病进展的年数更多（5±1.89对4.10±3.92，p<0.001）。通过DAS28测量的缓解情况在第1组中达到得更快（1.25±0.12对2.15±1.64，p<0.001）。严重感染尤其是疱疹病毒感染在第2组中更常见。
比较两组的临床改善情况，两组均实现了急性期反应物的降低以及通过DAS28测量的临床缓解，然而第2组（在6个月时）实现得更晚，这是因为他们的疾病进展年数更多且健康评估问卷（HAQ）更高。
