What is the role of rituximab in the treatment of rheumatoid arthritis (RA)?

Updated: Mar 05, 2021
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Rituximab is most often used in combination with MTX. It has been shown to be effective for reducing signs and symptoms in adult patients with moderately to severely active RA who have had an inadequate response to therapy with one or more TNF inhibitors. [94, 95, 96] The ORBIT study in 295 biological-treatment naive patients with RA found that initial treatment with rituximab is noninferior to initial TNF inhibitor treatment, and is cost saving over 12 months. [97]

Treatment with rituximab may deplete CD20+ B cells. A study by Bingham et al suggested that polysaccharide and primary immunizations should be administered before rituximab infusions in order to maximize treatment responses. [98] The study showed that responses to pneumococcal polysaccharide vaccine were less in RA patients receiving rituximab and MTX (57% showed a 2-fold rise in titer in response to 1 or more serotypes) than in those receiving MTX alone (82%).

Decreased response to keyhole limpet hemocyanin (KLH) (neoantigen) was also seen in the rituximab-treated patients (47% vs 93%). [98] However, the ability to maintain a positive delayed-type hypersensitivity to a Candida albicans skin test was comparable in both treatment groups, as was response to tetanus toxoid.

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