Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

Maya H Buch, Josef S Smolen, Neil Betteridge, Ferdinand C Breedveld, Gerd Burmester, Thomas Dörner, Gianfranco Ferraccioli, Jacques-Eric Gottenberg, John Isaacs, Tore K Kvien, Xavier Mariette, Emilio Martin-Mola, Karel Pavelka, Paul P Tak, Desiree van der Heijde, Ronald F van Vollenhoven, Paul Emery, Rituximab Consensus Expert Committee, Jordi Carbonell Abello, Marwan Bukhari, Harald Burkhardt, Bernard Combe, Juan-Jesus Gomez-Reino Carnota, Leonor Barile Fabris, Lars Klareskog, Jose Luis Marenco de la Fuente, Carlo-Maurizio Montecucco, Mikkel Ostergaard, Eliseo Pascual Gomez, Raimon Sanmarti Sala, Hans-Peter Tony, Guido Valesini, Jaap van Laar, Piet van Riel, Maya H Buch, Josef S Smolen, Neil Betteridge, Ferdinand C Breedveld, Gerd Burmester, Thomas Dörner, Gianfranco Ferraccioli, Jacques-Eric Gottenberg, John Isaacs, Tore K Kvien, Xavier Mariette, Emilio Martin-Mola, Karel Pavelka, Paul P Tak, Desiree van der Heijde, Ronald F van Vollenhoven, Paul Emery, Rituximab Consensus Expert Committee, Jordi Carbonell Abello, Marwan Bukhari, Harald Burkhardt, Bernard Combe, Juan-Jesus Gomez-Reino Carnota, Leonor Barile Fabris, Lars Klareskog, Jose Luis Marenco de la Fuente, Carlo-Maurizio Montecucco, Mikkel Ostergaard, Eliseo Pascual Gomez, Raimon Sanmarti Sala, Hans-Peter Tony, Guido Valesini, Jaap van Laar, Piet van Riel

Abstract

Background: Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab in the treatment of RA.

Methods: Preparation of this new document involved many international experts experienced in the treatment of RA. Following a meeting to agree upon the core agenda, a systematic literature review was undertaken to identify all relevant data. Data were then interrogated by a drafting committee, with subsequent review and discussion by a wider expert committee leading to the formulation of an updated consensus statement. These committees also included patients with RA.

Results: The new statement covers wide-ranging issues including the use of rituximab in earlier RA and impact on structural progression, and aspects particularly pertinent to rituximab such as co-medication, optimal dosage regimens, repeat treatment cycles and how to manage non-response. Biological therapy following rituximab usage is also addressed, and safety concerns including appropriate screening for hepatitis, immunoglobulin levels and infection risk. This consensus statement will support clinicians and inform patients when using B-cell depletion in the management of RA, providing up-to-date information and highlighting areas for further research.

Conclusion: New therapeutic strategies and treatment options for RA, a chronic destructive and disabling disease, have expanded over recent years. These have been summarised in general strategic suggestions and specific management recommendations, emphasising the importance of expedient disease-modifying antirheumatic drug implementation and tight disease control. This consensus statement is in line with these fundamental principles of management.

Conflict of interest statement

Competing interests All participants except the patient representative have been active on advisory boards or participated in clinical trials by the sponsor.

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