Featured Research

from universities, journals, and other organizations

New Treatment Strategy Offers Hope To Rheumatoid Arthritis Patients Who Failed All Other Therapies

Date:
June 18, 2009
Source:
European League Against Rheumatism
Summary:
Rheumatoid arthritis patients who failed to respond to initial treatment with rituximab (a chimeric monoclonal antibody against the protein CD20) can still be successfully re-treated with a second course of RTX after six months, according to new results.

Rheumatoid arthritis (RA) patients who failed to respond to initial treatment with rituximab (RTX) (a chimeric monoclonal antibody against the protein CD20) can still be successfully re-treated with a second course of RTX after six months, according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.

In the study, 72% of RA patients who did not respond to initial treatment with RTX achieved improved disease activity scores (DAS28) and EULAR responses when re-treated with RTX after six months. In some cases the responses were dramatic, with patients achieving complete remission for a year or longer.

Although the exact cause of rheumatoid arthritis is not complete understood, it is believed to involve B cells (part of the immune system) that become abnormal and cause the immune system to attack the joints. Rituximab works by killing B cells, removing the cause of the inflammation. B cells are gradually replaced over the next 6 to 12 months by new cells from the bone marrow. Rituximab is effective in approximately two thirds to three quarters of patients treated, however in some patients it is ineffective.

Under current licensing rituximab is generally used only when all other treatments (such as methotrexate or anti-TNF agents) have failed. This means that patients that fail to respond to rituximab usually have no other treatment available to them. Although new drugs are being developed for RA, this study demonstrates why rituximab treatment fails in some patients, and how it can be used more effectively to treat patients with the worst disease.

The study used a technique called highly sensitive flow cytometry that can accurately measure the very small numbers of B cells that remain in the system after treatment with rituximab. Initial studies with rituximab in RA seemed to show that all B cells were completely removed in all patients, even those that failed to show an improvement in symptoms and signs of arthritis after treatment. Highly sensitive flow cytometry shows that B cells are not always completely removed, and almost all patients that fail to improve after rituximab have incomplete B cell depletion. In addition, patients in whom B cell depletion is incomplete have higher numbers of certain B cells (preplasma and memory B cells) before treatment.

In the study, 104 patients (with complete data) were treated with rituximab and depletion assessed using highly sensitive flow cytometry. 90% of patients who did not respond clinically to treatment had incomplete B cell depletion. Non-response could also be predicted by higher baseline levels of memory B cells (p= 0.027) and preplasma cells (p= 0.006). 25 patients who had failed to respond to an initial treatment with rituximab were retreated six months later. At this stage B cells had not yet recovered to pre-treatment levels. Re-treating with a second course of rituximab resulted in greater B cell depletion, with 48% now achieving complete depletion (p = 0.02). 72% of these patients then responded clinically, as defined by a moderate or better EULAR response. 32% had a good response and 16% were in remission. A significant improvement was observed in DAS28* (p < 0.001) and all its components of DAS28.

Dr Edward Vital of Leeds Institute of Molecular Medicine, University of Leeds, UK, who led the study, said: "Although rituximab can be effective in RA, around a third of patients fail to achieve an adequate response the first time they are treated. Our study has shown that re-treating patients at a specific stage can enhance clinical responses to a level equal to those who fully respond to the RTX course at first administration. This provides hope for patients who are classified as non-responders and would normally have limited other treatment options. The next question is whether patients who have predictors of poor response could be treated more intensively from the outset, for example with a different dose of rituximab."

* DAS28 (Disease Activity Score) is an index used by physicians to measure how active an individual's RA is. It assesses number of tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patient's 'global assessment of global health'. A higher score indicates more active disease.


Story Source:

The above story is based on materials provided by European League Against Rheumatism. Note: Materials may be edited for content and length.


Cite This Page:

European League Against Rheumatism. "New Treatment Strategy Offers Hope To Rheumatoid Arthritis Patients Who Failed All Other Therapies." ScienceDaily. ScienceDaily, 18 June 2009. <www.sciencedaily.com/releases/2009/06/090611110946.htm>.
European League Against Rheumatism. (2009, June 18). New Treatment Strategy Offers Hope To Rheumatoid Arthritis Patients Who Failed All Other Therapies. ScienceDaily. Retrieved August 29, 2014 from www.sciencedaily.com/releases/2009/06/090611110946.htm
European League Against Rheumatism. "New Treatment Strategy Offers Hope To Rheumatoid Arthritis Patients Who Failed All Other Therapies." ScienceDaily. www.sciencedaily.com/releases/2009/06/090611110946.htm (accessed August 29, 2014).

Share This




More Health & Medicine News

Friday, August 29, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

3 Things To Know About The Ebola Outbreak's Progression

3 Things To Know About The Ebola Outbreak's Progression

Newsy (Aug. 29, 2014) Here are three things you need to know about the deadly Ebola outbreak's progression this week. Video provided by Newsy
Powered by NewsLook.com
Killer Amoeba Found in Louisiana Water System

Killer Amoeba Found in Louisiana Water System

AP (Aug. 28, 2014) State health officials say testing has confirmed the presence of a killer amoeba in a water system serving three St. John the Baptist Parish towns. (Aug. 28) Video provided by AP
Powered by NewsLook.com
Who Could Be Burnt by WHO's E-Cigs Move?

Who Could Be Burnt by WHO's E-Cigs Move?

Reuters - Business Video Online (Aug. 28, 2014) The World Health Organisation has called for the regulation of electronic cigarettes as both tobacco and medical products. Ciara Lee looks at the impact of the move on the tobacco industry. Video provided by Reuters
Powered by NewsLook.com
CDC Director On Ebola Outbreak: 'It's Worse Than I Feared'

CDC Director On Ebola Outbreak: 'It's Worse Than I Feared'

Newsy (Aug. 28, 2014) CDC director Tom Frieden says the Ebola outbreak is even worse than he feared. But he also said there's still hope to contain it. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins