Norbert Blank, Regina Max, Martin Schiller, Steffen Briem and Hanns-Martin Lorenz
SIR, Treatment of RA with rituximab (RTX) is established for patients with an inadequate response to anti-TNF-α therapy
[1–3]. Previous RTX trials show an ACR-70 response in ∼15% of all patients after 24 weeks [2, 3]. Therefore, a significant fraction of RA patients cannot be treated sufficiently. Other trials showed that combinations of etanercept (ETN) and anakinra [4] or ETN and abatacept [5] were associated with severe infections and are not recommended. Current guidelines propose that patients with an inadequate response to one or more anti-TNF-α drugs should switch to RTX therapy [6]. Recently published data suggest a switch to RTX after inefficacy of the first anti-TNF-α drug [7]. Current practice for switching to RTX is to discontinue ETN for 2 weeks, adalimumab (ADA) for 4 weeks and infliximab for 4–8 weeks before RTX therapy. However, it is not clear whether this is necessary to prevent infections or whether discontinuation leads to disease exacerbation.
We describe a retrospective analysis of 18 consecutively selected patients with long-standing active RA according to the …