In a recent study titled “Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previous TNF inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study,” recently published in the BMJ, Professor Paul Emery from the Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds in the UK and colleagues, aimed to compare the effectiveness of rituximab versus an alternative tumor necrosis factor (TNF) inhibitor (TNFi) in patients with rheumatoid arthritis (RA) with an inadequate response to one previous TNFi.
Tumor necrosis factor-α (TNF-α) inhibitors are effective options for patients with rheumatoid arthritis (RA), improving symptoms and preventing structural damage. However, studies have shown that about 40% of patients fail to respond adequately to these agents or lose responsiveness over time. Options for these patients include treatment with an alternative TNF inhibitor and switching to a biological therapy with a different mode of action.
Rituximab is a biological alternative (an anti-CD20 B-cell-depleting therapy), abatacept (a T-cell costimulation blocking agent) and, more recently, tocilizumab (anti-interleukin (IL)6 receptor monoclonal antibody) have been demonstrated to be significantly better than placebo in TNF-IR patients. However, data on the comparative effectiveness of different switching strategies are limited.
To address this unmet issue, the SWITCH-RA study, a prospective, global, observational study conducted in real-life practice conditions, aimed to compare the effectiveness of rituximab with an alternative TNF inhibitor in RA patients with an inadequate response to one previous TNF inhibitor.
For the study, which reported the 6-month primary effectiveness and safety data from SWITCH-RA, a total of 604 patients received rituximab, and 507 an alternative TNFi as second biological therapy, with results showing that the reasons for discontinuing the first TNFi were inefficacy (n=827), intolerance (n=263) and other (n=21). A total of 728 patients were available for primary end point analysis (rituximab n=405; TNFi n=323). Baseline mean (SD) DAS28-3–ESR was higher in the rituximab than the TNFi group: 5.2 (1.2) vs 4.8 (1.3).
According to the researchers, results indicate that after discontinuation of an initial TNFi, switching to rituximab is associated with significantly improved clinical effectiveness compared with switching to a second TNFi.