Rituximab-Therapie in der täglichen Praxis: besseres Therapieansprechen nach wiederholten Infusionszyklen

Zusammenfassung

Hintergrund:

Untersucht wurden RA Pat., die nach TNF-α Versagen mit wiederholten Rituximab Zyklen therapiert wurden.

Material und Methoden:

22 RA Pat. wurden von 5 Rheumatologen in der Praxis oder Ermächtigungsambulanz mit bis zu 4 Rituximab Zyklen behandelt. Untersucht wurden DAS28, BSG und CRP zum Zeitpunkt 0, 4, 6 Monate.

Ergebnisse:

Bei allen 22 Pat. bestand eine aktive Arthritis, DAS28 im Median 5,8, CRP 2,7 mg/dl, BSG 51 mm. Eine zunehmende signifikante Verbesserung des DAS28 und der Entzündungsparameter wurde im Behandlungsverlauf beobachtet, der DAS28 reduzierte sich von 5,8 auf 2,8 vor dem 4. Rituximab Zyklus. 13/22 (59%) erzielten einen low DAS28 (<3,2), 8/22 (36%) eine Remission (DAS28<2,6). Die Durchführung der Behandlungszyklen gestaltete sich problemlos in den Praxen, signifikante Nebenwirkungen traten nicht auf.

Schlussfolgerungen:

Das Ansprechen auf Rituximab nach TNF-α Versagen nimmt bei RA Pat. im Verlauf weiterer Behandlungszyklen zu. Trotz des höheren logistischen Aufwands ist die Therapie problemlos in der Praxis durchführbar.

Abstract

Background:

Rheumatoid arthritis (RA) patients in whom TNF-α therapy failed were treated with repeated rituximab cycles.

Patients and Methods:

22 RA patients were treated by 5 rheumatologists with up to 4 rituximab cycles. DAS28, CRP and ESR were assessed at 0, 4, 6 months.

Results:

All 22 patients had active arthritis prior to treatment, average DAS28 5.8, CRP 2.7 mg/dL, ESR 51 mm. A continued significant improvement of DAS28 and CRP, ESR were seen in the course of rituximab treatment, DAS28 improved from baseline 5.8 to 2.8 before the forth rituximab cycle. 13/22 (59%) reached a low DAS28 (<3.2), and 8/22 (36%) remission (DAS28<2.6). In daily rheumatological practice the rituximab therapy was carried out without problems, no significant side-effects occurred.

Conclusions:

The response to rituximab therapy following TNF-α failure improves with repeated infusion cycles. In spite of the long infusion time and necessary patient supervision, rituximab therapy can be carried out in daily rheumatological practice without problems.

Schlüsselwörter

Rheumatoide Arthritis - TNF-α Versagen - Rituximab - Biologika - wiederholte Infusionszyklen

Key words

rheumatoid arthritis - TNF-α failure - rituximab - biologicals - repeated infusion cycles

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