Second-line therapy for rheumatoid arthritis after first TNFi failure

In the scenario of failure of treatment with a TNF inhibitor, Rituximab can be a favourable option for second-line therapeutic intervention in rheumatoid arthritis patients.

To study the suitable alternative treatment after the initial Tumor Necrosis Factor inhibitors (TNFi) were ineffective for rheumatoid arthritis (RA) based on the fifteen years of data from the RHUMADATA, a real-life clinical database and registry.

Patients with RA were tracked until the treatment cessation, were lost to follow-up, or until November 2022. To distinguish the discontinuation rates between the cohorts, Kaplan-Meier and Cox regression techniques were used. To address potential attribution bias, missing data was filled in and propensity scores were calculated. Analyses were directed at complete, unadjusted, and propensity score-adjusted imputed datasets.

The study encompassed 611 patients, with 320 receiving TNFi (mean age of patients=44.5) and 291 (mean age of patients=43.9) treated with medicines of different mechanisms of action. Median retention times were 2.84 years for TNFi and 4.48 years for different mechanisms of action. A notably lower discontinuation rate in the different mechanism of action group compared to TNFi (adjusted Hazard Ratio (adjusted HR): 0.65; 95% Confidence Interval (CI): 0.44-0.94) as per the multivariable analysis. This finding persisted in propensity score-adjusted multiple imputation Cox models. Upon stratified analysis, Rituximab demonstrated superior retention than the first-line TNFi use after revising for patient characteristics (adjusted HR: 0.39; 95% CI: 0.18-0.84).

Shifting to medicines with another mechanism of action, particularly Rituximab, following the first TNFi failure appears as an ideal second-line therapy.