Rituximab reduced atherosclerosis progression in RA patients
Rituximab therapy reduced the progression of accelerated atherosclerosis in patients with rheumatoid arthritis, according to study results.
Researchers in Italy studied 38 patients with rheumatoid arthritis (RA; mean age, 66.7 years; 33 women) who failed to respond to anti-tumor necrosis factor treatment. At least two infusions of 1,000 mg rituximab (RTX), each given biweekly, were administered, and disease activity was evaluated at each visit.
Erythrocyte sedimentation rate, C-reactive protein (CRP) levels, Disease Activity Score 28 (DAS28), DAS28CRP, the Health Assessment Questionnaire, flow-mediated vasodilatation percent change from baseline (FMD%) and postnitroglycerine endothelium-independent vasodilatation were included in evaluations up to 24 months.
Patients significantly improved in clinical variables and acute-phase reactants 24 months after starting RTX therapy when compared with baseline, including DAS28 (5.84 ± 0.8 to 3.6 ± 0.1). FMD% improved (5.24 ± 1.12 to 5.43 ± 1.16) while carotid intima-media thickness (ccIMT) underwent a smaller change (0.69 ± 0.16 mm to 0.67 ± 0.12 mm; P=.25).
Global health (GH; P<.034) was associated with FMD% improvement, according to univariate analysis, and remained so under multivariate analysis (OR=0.91).
CD19+ cells (OR=1.024), immunoglobulin M (OR=1.025) and interleukin-8 (OR=0.487) also were statistically associated with FMD% improvement in multivariate analysis. IL-8 (OR=0.717) showed a further association with improved ccIMT.
“The change in FMD% appeared to be related to changes in disease activity, and the decrease in DAS28 suggests that inflammatory and immune-mediated mechanisms play a central role in both atherosclerosis and RA,” the researchers reported, “and that the two disorders have a number of common pathogenic mechanisms.
“These findings confirm the results obtained in animal models indicating that RTX plays a role in preventing accelerated atherosclerosis in RA patients. However, further studies of a large number of patients and national registers are required to validate these preliminary results.”