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Efficacy, Safety and Predictors of Response to Rituximab in Treatment of Iraqi Patients with Active Rheumatoid Arthritis

Authors: Sarah Tareq Abdulazeez --- Sami Salman --- Faiq I. Gorial
Journal: Al- Anbar Medical Journal مجلة الأنبار الطبية ISSN: PISSN: 27066207 / EISSN: 26643154 Year: 2019 Volume: 15 Issue: 1 Pages: 16-21
Publisher: University of Anbar جامعة الانبار

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Abstract

Background: Rituximab (RTX) is an anti-CD20 chimeric monoclonal antibody which effectivelydepletes B cells and is used for treating rheumatoid arthritis (RA).Objectives: To assess the efficacy and safety of RTX and to evaluate the predictors of responseto RTX in the treatment of Iraqi patients with active RA.Materials and methods: An open-labeled single group study that was conducted over 13 monthsin 65 patients with RA diagnosed according to a 1987 American College of Rheumatology (ACR)criteria. All patients were given 4 doses RTX by intravenous infusion over 6 months 1gm/dose.Each patient was followed at each visit of disease activity, including the Clinical Disease ActivityIndex (CDAI) and functional class (F Class). Also, we assess 9 different patients’ characteristics(age, gender, disease duration, the presence of RF, presence of ACPA, smoking status, previous useof TNF-blocker, the use of methotrexate and BMI) as predictors to RTX.Results: Data analysis showed significant improvement in CDAI (P value=0.005) and functionaldisability (P-value =0.001), and ESR (P-value =0.005) with RTX use over 6 months. The analysisalso showed that smoking has a negative correlation with response to treatment (p-value = 0.005).A better response was seen in RF-positive group. The other variables had no effects on the responseto treatment. The patients who switched from TNF-blocker were (29), and the patients who startedon RTX were 36 (either due to positive Purified Protein Derivative of a tuberculin test (PPD) orunavailability of TNF-blocker), results showed same RTX efficacy in both groups.Conclusion: RTX is effective both clinically (CDAI and F Class) and laboratory (ESR). It ismore effective in patients who are not smokers, and in those who are seropositive for RF. RTX isrelatively safe with few side effects, tolerable by most patients. The most common side effect is atransfusion reaction in the form of a sore throat.

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