• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Johns Hopkins Arthritis Center

Show Search
Hide Search
  • Disease Information
    • Rheumatoid Arthritis
    • Psoriatic Arthritis
    • Ankylosing Spondylitis
    • Osteoarthritis
    • Gout
    • Osteoporosis
  • Patient Corner
    • Drug Information Sheets
    • Managing Your Arthritis
    • RheumTV – Patient Education Video Library
  • Our Research
    • Patient-Centered Outcomes Research
    • Current Research Studies
    • The Camille Julia Morgan Arthritis Research and Education Fund
  • About Us
    • Appointment Information
    • Contact Us
    • Our Faculty
    • Our Staff
    • Rheumatology Specialty Centers
  • Donate
Home / Arthritis News / Rituximab Non-responders do not Benefit from Repeated Treatments

Rituximab Non-responders do not Benefit from Repeated Treatments

December 30, 2008 By Arthritis Center

Rituximab

The efficacy of rituximab, a monoclonal antibody directed against CD20 positive B cells, has been demonstrated for the treatment of rheumatoid arthritis (RA) in a number of key studies.  However, not all patients respond to therapy.  Whether patients with initial non-response may benefit from follow-up treatments (i.e. initial treatment resistance) has not been investigated.  Here, Thurlings et al (Arthritis Rheum 2008; 58 (12): 3657) report response rates for initial non-responders who received subsequent infusions of rituximab compared to those who responded to their first treatment course.

Methods

Patients with seropositive RA and active disease despite methotrexate therapy were treated with rituximab (1000 mg separated by 2 weeks).  After at least 6 months, all patients received a second treatment course if their DAS28 was > 3.2 (moderate disease activity or higher).  Responses after each treatment course were compared for the groups defined by initial clinical response (initial responder vs. initial non-responder).

Results

A total of 30 patients received a first treatment course.  Most (80%) were female with a median age of 55 years.  Most had established disease, with a median disease duration of 12 years at enrollment.  All had evidence of erosive disease on radiographs.  The mean DAS28 on presentation was 6.5.  The median methotrexate dosage was 15 mg/week and the majority (70%) was receiving low dose prednisone.
Among the 30 patient treated, 22 were categorized as initial responders and 8 as non-responders.  Of the 22 initial responders, 17 received a 2nd treatment course and 14 were noted to respond.  Of the 8 initial non-responders, 7 received a 2nd treatment course and none were noted to respond.
Among the 17 initial responders who received a 2nd treatment, 12 received a 3rd treatment course.  Among these, all had at least a EULAR moderate or good response.  The remaining 4 patients who received a 2nd treatment course were not retreated due to sustained low disease activity.  Of the 7 initial non-responders who received a 2nd treatment course, 4 received a 3rd treatment.  Of these, 1 achieved a EULAR moderate response, but none achieved a EULAR good response.

Conclusions

RA patients who do not respond to their first treatment course of rituximab will not benefit from subsequent treatments, while most that benefit from the first treatment course will have a sustained response with retreatment.

Editorial Comment

Although this is a small study, the striking differences between the groups provide convincing evidence that retreatment of initial rituximab non-responders is futile.  These findings are important for clinical practice, as the time required to retreat and follow for a response in an initial non-responder can be better served by initiating therapy with a different mechanism of action.  In addition, these findings suggest that seropositive RA patients may fall into different subsets based on B cell pathogenesis.

Receive the Latest News from Johns Hopkins Rheumatology

Receive the Latest News from Johns Hopkins Rheumatology

Join our mailing list to receive the latest news and updates from Johns Hopkins Rheumatology.

Interested In

You have Successfully Subscribed!

Arthritis Center

Founded in 1998, the Arthritis Center at Johns Hopkins is dedicated to providing quality education to patients and healthcare providers alike.

Use of this Site

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

Primary Sidebar

Recent News

Exercise Tips for Arthritis Patients

How Does Exercise Affect my Joints? How Frequently Should I Be Exercising? Should I Lose Weight for Exercise to be

Risks and Benefits of Biologic Medications

Victoria Ruffing, RN, BC, Director of Patient Education at the Johns Hopkins Arthritis Center, shares the risks and benefits of biologic for

How to Manage Rheumatoid Arthritis Flares

Through research, doctors have a clearer understanding of how flares can impact a patient on a personal and emotional level. Dr. Uzma Haque

Complementary & Alternative Medicines for Psoriatic Arthritis

There are many complementary & alternative medicines and practices that have been found to be beneficial in curbing arthritis pain,

I can’t be a runner because I have Rheumatoid Arthritis (RA), right?

Dr. Manno discusses running and Rheumatoid Arthritis. Is it an option for the RA patient?

News Categories

  • Ankylosing Spondylitis News
  • Fibromyalgia News
  • Gout News
  • Lupus News
  • Osteoarthritis News
  • Osteoporosis News
  • Psoriatic Arthritis News
  • Rheumatoid Arthritis News
RheumTV Logo

Rheum.TV is an informational platform created to educate patients living with a rheumatic disease. With over 100 disease education videos produced by the team at Johns Hopkins Rheumatology.

Visit Rheum.TV

Footer

Johns Hopkins Rheumatology

  • Johns Hopkins Rheumatology
  • Johns Hopkins Lupus Center
  • Johns Hopkins Lyme Disease Research Center
  • Johns Hopkins Myositis Center
  • Johns Hopkins Scleroderma Center
  • Johns Hopkins Sjögren’s Syndrome Center
  • Johns Hopkins Vasculitis Center

Connect With Us

  • Facebook
  • Twitter
  • YouTube

Johns Hopkins Medicine

© 2023 Johns Hopkins Arthritis Center
Patient Privacy