Rituximab was shown to be a cost-effective second-line treatment for individuals with rheumatoid arthritis in a recent article from University Hospital Santa Maria della Misericordia in Italy. A team from the hospital and collaborating institutions conducted a study involving 102 patients with rheumatoid arthritis undergoing one of two treatment regimens in order to understand the costs and resultant increases in quality of life. The less intense regimen, which consisted of treatment at the time of clinical relapse, was at least as cost-effective as the more intense regimen used in the study.
The first line of treatment for rheumatoid arthritis is tumor necrosis factor (TNF) inhibitors. When this treatment fails to produce a response in patients, a second line of treatment is necessary. Rituximab combined with methotrexate is indicated for retreatment, but the cost-effectiveness of the ways of treatment delivery had not been well studied thus far.
“During the global clinical trial development of rituximab in rheumatoid arthritis, two retreatment regimens were adopted,” wrote Luca Quartuccio, MD, PhD, lead author of the paper. “Retreatment at the time of clinical relapse (treatment as needed; regimen 1)… [or] a fixed retreatment course at month six if remission with the Disease Activity Score in 28 joints (DAS28) was not achieved (regimen 2).”
The researchers split the recruited patients nearly evenly into the two regimens. Regimen 1 (treatment as needed) delivered full rituximab treatment over the course of 2 weeks. Regimen 2 (fixed 6-month retreatment) also delivered a full retreatment course over 2 weeks, but treatment was started at month 6 and then continued as necessary in the future if DAS28 did not improve.
To analyze the cost-effectiveness of these two regimens, the researchers created a simulation that incorporated data of the health states of each of the evaluated patients. This model used four stages of disease: treatment, response, relapse, and death. If patients experienced two relapses or two instances of lack of response, they were removed from the model.
At the end, “Cost-Effectiveness Analysis of Two Rituximab Retreatment Regimens for Longstanding Rheumatoid Arthritis,” which was published in Arthritis Care & Research, reported that “Regimen 1 was dominant in being less costly and associated with a higher quality of life when compared to regimen 2 in all scenarios.” Clearly, patients who are treated with the less intense regimen benefit just as much as those patients who are treated with the intense regimen.