Safety of combination therapy with rituximab and etanercept for patients with rheumatoid arthritis
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  or ETN and abatacept  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 . Recently published data suggest a switch to RTX after inefficacy of the first anti-TNF-α drug . 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 …
Ver artigo completo