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Jamois C, Gibiansky L, Chavanne C, Cheu M, Lehane PB, Pordeli P, Melega S, Gaudreault J. Rituximab pediatric drug development: Pharmacokinetic and pharmacodynamic modeling to inform regulatory approval for rituximab treatment in patients with granulomatosis with polyangiitis or microscopic polyangiitis. Clin Transl Sci 2022; 15:2172-2183. [PMID: 35765176 PMCID: PMC9468568 DOI: 10.1111/cts.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 01/25/2023] Open
Abstract
Anti-neutrophil cytoplasmic antibody-associated vasculitides granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are rare, potentially organ- and life-threatening autoimmune conditions affecting adult and pediatric patients. An open-label phase II study was conducted to determine safe and effective dosing regimens of rituximab in pediatric patients with GPA/MPA. To determine the selection of an appropriate dose regimen in children for induction and maintenance, a population pharmacokinetic approach was used (nonlinear mixed-effect modeling), combining pediatric data with data from adults with GPA/MPA. The time course of B-cell depletion was assessed in both populations. The exposure-effect relationship was assessed by logistic regression. Twenty-five pediatric patients (80% female patients; age range, 6-17 years) were enrolled in the trial and received the induction regimen of intravenous rituximab 375 mg/m2 weekly for 4 weeks, which resulted in a similar exposure to that of adults. Based on pharmacokinetic modeling, a maintenance dosing regimen of 250 mg/m2 administered twice over 14 days followed by 250 mg/m2 every 6 months is expected to result in similar rituximab exposure as that of adults receiving the approved maintenance dose of 500 mg administered twice over 14 days followed by 500 mg every 6 months. The time course of B-cell depletion was similar between the pediatric and adult populations, supporting the similarities in response in both populations and allowing extrapolation to patients less than 6 years old. Using a partial extrapolation approach helped identify safe and effective dosing regimens of rituximab in pediatric patients with GPA/MPA and lead to regulatory approval.
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Affiliation(s)
- Candice Jamois
- Clinical Pharmacology, Pharmaceutical Sciences, Pharma Research and Early DevelopmentRoche Innovation Center BaselBaselSwitzerland
| | | | - Clarisse Chavanne
- Clinical Pharmacology, Pharmaceutical Sciences, Pharma Research and Early DevelopmentRoche Innovation Center BaselBaselSwitzerland
| | - Melissa Cheu
- BioAnalytical SciencesGenentech Inc.South San FranciscoCaliforniaUSA
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Melega S, Brogan P, Cleary G, Hersh AO, Kasapcopur O, Rangaraj S, Yeung RSM, Zeft A, Cooper J, Pordeli P, Kirchner P, Lehane PB. Evaluation of Serious Infection in Pediatric Patients with Low Immunoglobulin Levels Receiving Rituximab for Granulomatosis with Polyangiitis or Microscopic Polyangiitis. Rheumatol Ther 2022; 9:721-734. [PMID: 35279811 PMCID: PMC8964878 DOI: 10.1007/s40744-022-00433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/10/2022] [Indexed: 10/28/2022] Open
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Merkel PA, Niles JL, Mertz LE, Lehane PB, Pordeli P, Erblang F. Long-Term Safety of Rituximab in Granulomatosis With Polyangiitis and in Microscopic Polyangiitis. Arthritis Care Res (Hoboken) 2021; 73:1372-1378. [PMID: 32475029 PMCID: PMC8457173 DOI: 10.1002/acr.24332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/19/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The present study was undertaken to conduct a phase IV, open-label, prospective study to characterize the long-term safety of rituximab in a 4-year observational registry of adult patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) within the US. METHODS Patients initiating treatment with rituximab were evaluated every 6 months for up to 4 years. Outcomes included the incidence of serious adverse events (SAEs), infusion-related reactions (IRRs), and SAEs of specific interest, including serious infections, serious cardiac events, serious vascular events, and malignancies. RESULTS Overall, 97 patients (72 with GPA and 25 with MPA) received rituximab through a median of 8 (range 1-28) infusions and were followed up for a median of 3.94 years (range 0.05-4.32 years). The estimated incidence rates (95% confidence interval [95% CI]) of serious infections, serious cardiac events, and serious vascular events were 7.11 (4.55-10.58), 5.03 (2.93-8.06), and 2.37 (1.02-4.67) per 100 patient-years (PYs), respectively. No IRRs or SAEs occurred within 24 hours of an infusion of rituximab. None of the 9 deaths reported (crude mortality rate 2.67 [95% CI 1.22-5.06] per 100 PYs) were considered to be related to use of rituximab. CONCLUSION The safety profile of long-term treatment with rituximab in patients with GPA or MPA was consistent with that of rituximab administered for shorter durations and with rituximab's known safety profile in other autoimmune diseases for which it has received regulatory approval. These findings provide clinicians with long-term, practice-level safety data for rituximab in the treatment of GPA or MPA.
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Brogan P, Yeung RSM, Cleary G, Rangaraj S, Kasapcopur O, Hersh AO, Li S, Paripovic D, Schikler K, Zeft A, Bracaglia C, Eleftheriou D, Pordeli P, Melega S, Jamois C, Gaudreault J, Michalska M, Brunetta P, Cooper JC, Lehane PB. Phase IIa Global Study Evaluating Rituximab for the Treatment of Pediatric Patients With Granulomatosis With Polyangiitis or Microscopic Polyangiitis. Arthritis Rheumatol 2021; 74:124-133. [PMID: 34164952 PMCID: PMC9299798 DOI: 10.1002/art.41901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 05/17/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Objective To assess the safety, tolerability, pharmacokinetics, and efficacy of rituximab (RTX) in pediatric patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). Methods The Pediatric Polyangiitis Rituximab Study was a phase IIa, international, open‐label, single‐arm study. During the initial 6‐month remission‐induction phase, patients received intravenous infusions of RTX (375 mg/m2 body surface area) and glucocorticoids once per week for 4 weeks. During the follow‐up period, patients could receive further treatment, including RTX, for GPA or MPA. The safety, pharmacokinetics, pharmacodynamics, and exploratory efficacy outcomes with RTX were evaluated. Results Twenty‐five pediatric patients with new‐onset or relapsing disease were enrolled at 11 centers (19 with GPA [76%] and 6 with MPA [24%]). The median age was 14 years (range 6–17 years). All patients completed the remission‐induction phase. During the overall study period (≤4.5 years), patients received between 4 and 28 infusions of RTX. All patients experienced ≥1 adverse event (AE), mostly grade 1 or grade 2 primarily infusion‐related reactions. Seven patients experienced 10 serious AEs, and 17 patients experienced 31 infection‐related AEs. No deaths were reported. RTX clearance correlated with body surface area. The body surface area–adjusted RTX dosing regimen resulted in similar exposure in both pediatric and adult patients with GPA or MPA. Remission, according to the Pediatric Vasculitis Activity Score, was achieved in 56%, 92%, and 100% of patients by months 6, 12, and 18, respectively. Conclusion In pediatric patients with GPA or MPA, RTX is well tolerated and effective, with an overall safety profile comparable to that observed in adult patients with GPA or MPA who receive treatment with RTX. RTX is associated with a positive risk/benefit profile in pediatric patients with active GPA or MPA.
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Affiliation(s)
- Paul Brogan
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Rae S M Yeung
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Ozgur Kasapcopur
- Istabul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Aimee O Hersh
- University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - Suzanne Li
- Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Andrew Zeft
- The Cleveland Clinic, Center for Pediatric Rheumatology & Immunology, Cleveland, OH, USA
| | | | - Despina Eleftheriou
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | - Jennifer C Cooper
- Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Emery P, Furst DE, Kirchner P, Melega S, Lacey S, Lehane PB. Risk of Malignancies in Patients with Rheumatoid Arthritis Treated with Rituximab: Analyses of Global Postmarketing Safety Data and Long-Term Clinical Trial Data. Rheumatol Ther 2020; 7:121-131. [PMID: 31754941 PMCID: PMC7021875 DOI: 10.1007/s40744-019-00183-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) are at an increased risk of developing malignancies, but it is unclear whether this increased risk is the result of disease pathobiology or immunosuppressant treatments for RA. This analysis evaluated the potential risk of malignancy in patients with RA treated with rituximab (MabThera®/Rituxan®) a CD20+ B-cell depleting agent manufactured by F. Hoffmann-La Roche Ltd. METHODS Malignancy rates were obtained from the rituximab global company safety database for adverse event reporting and from the rituximab global clinical trial program for RA consisting of eight randomized clinical trials, two long-term open-label extensions, and one open-label prospective study. Global company safety database searches were performed using the standard Medical Dictionary for Regulatory Activities (MedDRA) queries "Malignant tumors wide" and "Skin malignant tumors wide" up to April 30, 2017. Age- and sex-specific comparator values from the general population were obtained from the US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. RESULTS For the 409,706 patients with RA in the rituximab global company safety database since first market approval in 2006, 1739 cumulative malignant events were reported, with an overall malignancy reporting rate of approximately 4.2 events per 1000 patients. No evidence of increased risk of malignancy, of any organ-specific type, was found following rituximab treatment. The rate of malignancies from rituximab-treated patients in RA clinical trials was 7.4 per 1000 patient-years. This is within the expected range, with no evidence for increased risk over time or with additional rituximab courses. CONCLUSIONS Analyses of the global postmarketing safety database and long-term clinical trial data showed no evidence of an increased risk of malignancy of any type following rituximab treatment in patients with RA. FUNDING F. Hoffmann-La Roche Ltd.
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Affiliation(s)
- Paul Emery
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds University, Leeds, UK
| | - Daniel E Furst
- University of California, Los Angeles, Los Angeles, CA, USA
- University of Washington, Seattle, WA, USA
- University of Florence, Florence, Italy
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Berger JR, Malik V, Lacey S, Brunetta P, Lehane PB. Correction to: Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event. J Neurovirol 2018; 24:332. [PMID: 29637430 DOI: 10.1007/s13365-018-0637-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The article "Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event," written by Joseph R. Berger, Vineeta Malik, Stuart Lacey, Paul Brunetta, and Patricia B. Lehane3, was originally published electronically on the publisher's internet portal (currently SpringerLink).
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Affiliation(s)
- Joseph R Berger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Convention Avenue, Room 765, Philadelphia, PA, 19104, USA.
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van Vollenhoven RF, Fleischmann RM, Furst DE, Lacey S, Lehane PB. Longterm Safety of Rituximab: Final Report of the Rheumatoid Arthritis Global Clinical Trial Program over 11 Years. J Rheumatol 2015; 42:1761-6. [PMID: 26276965 DOI: 10.3899/jrheum.150051] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Final evaluation of the longterm safety of rituximab (RTX) in rheumatoid arthritis (RA) up to 11 years. METHODS Pooled observed case analysis of data from patients with moderate to severe, active RA in a global clinical trial program. RESULTS As of September 2012, 3595 patients received a mean of 4 courses (range 1-20) of RTX over 11 years [14,816 patient-years (PY)]. Of these, 1246 patients had > 5 years of followup (8970 PY). A pooled placebo population (n = 818) was included in the analysis. The overall serious infection event (SIE) rate was 3.76/100 PY (2.71/100 PY in patients observed for > 5 yrs) and comparable with rates reported previously at 9.5 years (3.94/100 PY and 3.26/100 PY, respectively). SIE rates continued to be similar before and during/after development of low immunoglobulin levels, and serious opportunistic infections remained rare. Rates of cardiac events remained consistent with previous analysis and with rates in the general RA population. No increased risk of malignancy over time was observed. CONCLUSION This final report demonstrates that RTX remains well tolerated over time and multiple courses. No new safety risks were identified and there was no increase in the rate of any types of adverse events with prolonged exposure to RTX during 11 years of observation.
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Affiliation(s)
- Ronald F van Vollenhoven
- From the Unit for Clinical Therapy Research, Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden; Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas; Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, California, USA; Roche Products Ltd., Welwyn Garden City, UK.R.F. van Vollenhoven, MD, Chief of the Unit for Clinical Therapy Research, Inflammatory Disease, Karolinska Institute; R.M. Fleischmann, MD, Clinical Professor of Medicine, Department of Internal Medicine, University of Texas, Southwestern Medical Center; D.E. Furst, MD, Carl M. Pearson Professor of Medicine, Department of Rheumatology, University of California, Los Angeles Medical Center; S. Lacey, MSc, Statistician, Roche Products Ltd.; P.B. Lehane, PhD, Senior Clinical Development Scientist, Roche Products Ltd.
| | - Roy M Fleischmann
- From the Unit for Clinical Therapy Research, Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden; Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas; Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, California, USA; Roche Products Ltd., Welwyn Garden City, UK.R.F. van Vollenhoven, MD, Chief of the Unit for Clinical Therapy Research, Inflammatory Disease, Karolinska Institute; R.M. Fleischmann, MD, Clinical Professor of Medicine, Department of Internal Medicine, University of Texas, Southwestern Medical Center; D.E. Furst, MD, Carl M. Pearson Professor of Medicine, Department of Rheumatology, University of California, Los Angeles Medical Center; S. Lacey, MSc, Statistician, Roche Products Ltd.; P.B. Lehane, PhD, Senior Clinical Development Scientist, Roche Products Ltd
| | - Daniel E Furst
- From the Unit for Clinical Therapy Research, Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden; Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas; Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, California, USA; Roche Products Ltd., Welwyn Garden City, UK.R.F. van Vollenhoven, MD, Chief of the Unit for Clinical Therapy Research, Inflammatory Disease, Karolinska Institute; R.M. Fleischmann, MD, Clinical Professor of Medicine, Department of Internal Medicine, University of Texas, Southwestern Medical Center; D.E. Furst, MD, Carl M. Pearson Professor of Medicine, Department of Rheumatology, University of California, Los Angeles Medical Center; S. Lacey, MSc, Statistician, Roche Products Ltd.; P.B. Lehane, PhD, Senior Clinical Development Scientist, Roche Products Ltd
| | - Stuart Lacey
- From the Unit for Clinical Therapy Research, Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden; Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas; Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, California, USA; Roche Products Ltd., Welwyn Garden City, UK.R.F. van Vollenhoven, MD, Chief of the Unit for Clinical Therapy Research, Inflammatory Disease, Karolinska Institute; R.M. Fleischmann, MD, Clinical Professor of Medicine, Department of Internal Medicine, University of Texas, Southwestern Medical Center; D.E. Furst, MD, Carl M. Pearson Professor of Medicine, Department of Rheumatology, University of California, Los Angeles Medical Center; S. Lacey, MSc, Statistician, Roche Products Ltd.; P.B. Lehane, PhD, Senior Clinical Development Scientist, Roche Products Ltd
| | - Patricia B Lehane
- From the Unit for Clinical Therapy Research, Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden; Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas; Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, California, USA; Roche Products Ltd., Welwyn Garden City, UK.R.F. van Vollenhoven, MD, Chief of the Unit for Clinical Therapy Research, Inflammatory Disease, Karolinska Institute; R.M. Fleischmann, MD, Clinical Professor of Medicine, Department of Internal Medicine, University of Texas, Southwestern Medical Center; D.E. Furst, MD, Carl M. Pearson Professor of Medicine, Department of Rheumatology, University of California, Los Angeles Medical Center; S. Lacey, MSc, Statistician, Roche Products Ltd.; P.B. Lehane, PhD, Senior Clinical Development Scientist, Roche Products Ltd
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Affiliation(s)
- P B Lehane
- Roche Products Ltd, Welwyn Garden City, England, UK
| | - S Lacey
- Roche Products Ltd, Welwyn Garden City, England, UK
| | - E W Hessey
- Roche Products Ltd, Welwyn Garden City, England, UK
| | - A Jahreis
- Genentech Inc, South San Francisco, California, USA
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van Vollenhoven RF, Emery P, Bingham CO, Keystone E, Fleischmann RM, Furst DE, Hessey EW, Mehbob A, Lehane PB. 106. Long-Term Safety of Rituximab: Pooled Analysis of the Rheumatoid Arthritis Global Clinical Trial Programme Over 11 Years. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu101.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van Vollenhoven RF, Emery P, Bingham CO, Keystone EC, Fleischmann RM, Furst DE, Tyson N, Collinson N, Lehane PB. Long-term safety of rituximab in rheumatoid arthritis: 9.5-year follow-up of the global clinical trial programme with a focus on adverse events of interest in RA patients. Ann Rheum Dis 2013; 72:1496-502. [PMID: 23136242 PMCID: PMC3756452 DOI: 10.1136/annrheumdis-2012-201956] [Citation(s) in RCA: 257] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Evaluation of long-term safety of rituximab in rheumatoid arthritis (RA). METHODS Pooled observed case analysis of data from patients with moderate-to-severe, active RA treated with rituximab in a global clinical trial programme. RESULTS As of September 2010, 3194 patients had received up to 17 rituximab courses over 9.5 years (11 962 patient-years). Of these, 627 had >5 years' follow-up (4418 patient-years). A pooled placebo population (n=818) (placebo+methotrexate (MTX)) was also analysed. Serious adverse event and infection rates generally remained stable over time and multiple courses. The overall serious infection event (SIE) rate was 3.94/100 patient-years (3.26/100 patient-years in patients observed for >5 years) and was comparable with placebo+MTX (3.79/100 patient-years). Serious opportunistic infections were rare. Overall, 22.4% (n=717) of rituximab-treated patients developed low immunoglobulin (Ig)M and 3.5% (n=112) low IgG levels for ≥4 months after ≥1 course. SIE rates were similar before and during/after development of low Ig levels; however, in patients with low IgG, rates were higher than in patients who never developed low IgG. Rates of myocardial infarction and stroke were consistent with rates in the general RA population. No increased risk of malignancy over time was observed. CONCLUSIONS This analysis demonstrates that rituximab remains generally well tolerated over time and multiple courses, with a safety profile consistent with published data and clinical trial experience. Overall, the findings indicate that there was no evidence of an increased safety risk or increased reporting rates of any types of adverse events with prolonged exposure to rituximab during the 9.5 years of observation.
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Keystone EC, Cohen SB, Emery P, Kremer JM, Dougados M, Loveless JE, Chung C, Wong P, Lehane PB, Tyrrell H. Multiple courses of rituximab produce sustained clinical and radiographic efficacy and safety in patients with rheumatoid arthritis and an inadequate response to 1 or more tumor necrosis factor inhibitors: 5-year data from the REFLEX study. J Rheumatol 2012; 39:2238-46. [PMID: 23027887 DOI: 10.3899/jrheum.120573] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This 5-year observational posthoc analysis of the REFLEX study and its open-label extension assessed clinical efficacy, radiographic response, and safety of rituximab (RTX) in patients with rheumatoid arthritis (RA) who had an inadequate response to tumor necrosis factor (TNF) inhibitors. METHODS Patients in REFLEX were originally randomized to placebo (PBO) + methotrexate (MTX; PBO-randomized) or RTX + MTX (RTX-randomized). PBO-randomized patients were rescued with RTX as appropriate. Patients responding to initial RTX treatment could receive further RTX courses. For clinical efficacy and safety analyses, PBO-randomized patients were re-baselined prior to first RTX treatment and the data were pooled with RTX-randomized patient data. Efficacy outcomes 24 weeks after each course were calculated relative to first RTX pretreatment baseline. Radiographic outcomes were assessed relative to randomization baseline for both PBO-randomized and RTX-randomized groups. RESULTS A total of 480 patients received ≥ 1 RTX course. At 24 weeks, American College of Rheumatology 20/50/70 responses were 62.0%, 30.8%, and 13.0%, respectively at course 1 (n = 400) and 70.3%, 41.8%, and 22.0% at course 5 (n = 91). European League Against Rheumatism good/moderate responses were 77.2% and 84.4% at courses 1 (n = 390) and 5 (n = 90). Rates of adverse events (AE), serious AE, and infections generally remained stable. Rate of progressive joint damage (PJD; change in mean Total Sharp Score) decreased over time in both PBO-randomized (n = 79) and RTX-randomized (n = 105) groups. Mean change from baseline in PJD over 5 years was greater in PBO-randomized versus RTX-randomized patients (5.51 vs 3.21). CONCLUSION RTX re-treatment over 5 years is associated with maintained or improved efficacy, continued inhibition of PJD, and a safety profile consistent with that previously reported. A delay in initiating RTX treatment may result in increased PJD.
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Affiliation(s)
- Edward C Keystone
- Mount Sinai Hospital and the University of Toronto, Toronto, Ontario, Canada.
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Strand V, Balbir-Gurman A, Pavelka K, Emery P, Li N, Yin M, Lehane PB, Agarwal S. Sustained benefit in rheumatoid arthritis following one course of rituximab: improvements in physical function over 2 years. Rheumatology (Oxford) 2006; 45:1505-13. [PMID: 17062648 DOI: 10.1093/rheumatology/kel358] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the long-term impact on physical function of a single course of rituximab in rheumatoid factor, seropositive patients with active rheumatoid arthritis (RA) despite ongoing methotrexate treatment. METHODS A randomized, controlled trial comparing rituximab alone [1,000 mg intravenously (iv) on days 1 and 15, n= 40], or in combination with cyclophosphamide (750 mg iv on days 3 and 7, n= 41) or oral methotrexate (> or =10 mg/week, n= 40) with placebo + methotrexate (> or =10 mg/week, n= 40), resulted in significant reductions in disease activity at weeks 24 and 48. Sustained improvements in physical function and standard effect sizes (SES) for changes in components of ACR and EULAR criteria were evaluated over 2 yrs. RESULTS More patients receiving rituximab + methotrexate completed a 2-yr follow-up without further treatment than those receiving placebo + methotrexate (45% vs 15%, respectively), rituximab alone (10%) or rituximab + cyclophosphamide (22%). This reflected a higher percentage of patients receiving rituximab + methotrexate reporting improvements in Health Assessment Questionnaire Disability Index > or = minimum clinically important difference at 1 and 2 yrs (68% and 30%, respectively) compared with placebo + methotrexate (28% and 15%), rituximab monotherapy (43% and 10%) or rituximab + cyclophosphamide (39% and 12%). SES were high in all rituximab groups and revealed differing patterns of response over time. CONCLUSION A single course of rituximab with continuing methotrexate in patients with active RA provided clinically meaningful improvements in physical function over 2 yrs, with lower discontinuation rates and larger SES for improvements in ACR and EULAR criteria components.
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Affiliation(s)
- V Strand
- Division of Immunology, Stanford University, Palo Alto, CA, USA.
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