Norris-Grey Caitlin, Cambridge Geraldine, Moore Samantha, Reddy Venkat, Leandro Maria
Centre for Rheumatology Research, University College London.
University College London Hospitals, UK.
Rheumatology (Oxford). 2022 Feb 2;61(2):591-596. doi: 10.1093/rheumatology/keab248.
B cell depletion therapy based on rituximab in patients with RA was pioneered at University College London Hospitals/University College London in 1998. The objective of this study was to evaluate long-term persistence of rituximab and identify factors associated with discontinuation of treatment.
Retrospective review of medical records from all rituximab-treated RA patients followed up in a dedicated clinic (1998-2020). Data collected included gender, disease duration, previous DMARDs, autoantibody status, age and concomitant therapy at first cycle, length of follow-up, and number of cycles. Drug survival and factors associated with drug discontinuation were analysed using Kaplan-Meier survival curves, log-rank test and Cox regression analysis.
A total of 404 patients were included. Median disease duration and age at time of first rituximab cycle were 10 and 57 years, respectively. Median total follow-up was 55 months and median number of cycles five. 93.1% of patients were seropositive. Overall, 31.2% of patients stopped rituximab, with the largest reason for discontinuing being primary inefficacy (42.1%). Comparison of Kaplan-Meier curves showed that rituximab drug survival was lower in seronegative patients and in patients who had previously failed at least one biologic DMARD (bDMARD). Cox regression analysis revealed that rituximab discontinuation was associated with a greater number of previous bDMARDs.
Many patients with RA achieve good control of their disease with repeated cycles of rituximab treatment. The most common reasons for treatment discontinuation were either primary or secondary inefficacy. Patients who were seronegative and who had previously failed other bDMARDs were more at risk of drug discontinuation.
1998年，伦敦大学学院医院/伦敦大学学院率先在类风湿关节炎（RA）患者中开展基于利妥昔单抗的B细胞清除疗法。本研究的目的是评估利妥昔单抗的长期持续性，并确定与治疗中断相关的因素。
对在专门诊所随访的所有接受利妥昔单抗治疗的RA患者的病历进行回顾性分析（1998 - 2020年）。收集的数据包括性别、病程、既往使用的改善病情抗风湿药（DMARDs）、自身抗体状态、年龄以及首次治疗周期时的伴随治疗、随访时间长度和治疗周期数。使用Kaplan-Meier生存曲线、对数秩检验和Cox回归分析来分析药物生存率和与药物停用相关的因素。
共纳入404例患者。首次使用利妥昔单抗治疗周期时的病程中位数和年龄分别为10年和57岁。总随访时间中位数为55个月，治疗周期数中位数为5个。93.1%的患者血清学呈阳性。总体而言，31.2%的患者停用了利妥昔单抗，停用的最大原因是原发性无效（42.1%）。Kaplan-Meier曲线比较显示，血清学阴性患者和既往至少一种生物DMARD（bDMARD）治疗失败的患者中，利妥昔单抗药物生存率较低。Cox回归分析显示，利妥昔单抗停用与既往使用更多的bDMARDs相关。
许多RA患者通过重复使用利妥昔单抗治疗可实现疾病的良好控制。治疗中断的最常见原因是原发性或继发性无效。血清学阴性且既往其他bDMARDs治疗失败的患者停药风险更高。
