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Background: Rituximab, a pharmacological agent targeting B cells, is commonly employed in the treatment of rheumatoid arthritis, while its efficacy and safety in juvenile idiopathic arthritis (JIA) patients remain scarcely documented.
Objectives: This study aims at assessing the efficacy and safety of rituximab within a single-center cohort of adult JIA patients
Methods: Patients were retrospectively recruited at the Rheumatology Transition Clinic of our institution in case of: i) a JIA diagnosis according to the International League of Associations for Rheumatology (ILAR) criteria [1], ii) age of at least 18 years, and iii) a minimum of 6 months of rituximab therapy
Each course included two 1000 mg intravenous rituximab infusions 2 weeks apart, to be repeated based on clinical judgment every 24 weeks.
Results: This study included 22 subjects (7 with oligoarticular (O-) JIA, 13 with polyarticular (P-) JIA, 2 with enthesitis-related arthritis [ERA]), whose demographics and clinical details are summarized in Table 1. All recruited patients had a recalcitrant disease, with a median of two failed biologics before starting rituximab. In 45% of cases, patients received rituximab in association with methotrexate. With rituximab, a similar improvement in DAS28 scores was observed across all JIA categories. In particular, after 12 months of rituximab therapy, remission was achieved by 86% of the patients, with a 100% remission rate in the O-JIA subgroup, 84% in patients with P-JIA and 50% in those with ERA. No significant differences in disease duration, age at JIA onset, age at start of rituximab, positivity for rheumatoid factor and/or antibodies against cyclic citrullinated peptides were observed between responders and non-responders. The overall median duration of treatment was 7.1 years, with a longer median retention in treatment in the O-JIA subgroup (9.71 years). Treatment with rituximab was complicated by seven major infections in the whole cohort, with only two patients requiring hospitalization because of lobar pneumonia and osteomyelitis due to Haemophilus influenzae.
Conclusion: Rituximab allows controlling disease activity across different JIA categories, even in patients who have not responded to prior biological treatments. Rituximab demonstrates a tolerable safety profile.
REFERENCES: [1] Petty RE, International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004;31:390–2.
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O-JIA
|
P-JIA
|
ERA- JIA
|
| Total cohort (n=22 ) | |
|---|---|---|---|---|---|
| Age at JIA onset, median (IQR) | 3.7 (9.3) | 14.6 (9.3) | 1.8 (0.8) | 0.438 | 30.0 (6.82) |
| Age at JIA diagnosis, median (IQR) | 3.8 (10.0) | 15 (10.2) |
| 0.351 | 8.7 (14.5) |
| MTX monotherapy before bDMARDs treatment % (n) | 85.7 (6) | 69.2 (9) | 50 (1) | 0.550 | 72 (16) |
| LEF monotherapy before bDMARDs % (n) | 14.2 (1) | 15.38 (2) | 0 (0) | 0.839 | 17 (3) |
| Age at starting treatment with RTX, median (IQR) | 17 (12) | 19 (7) | 29.5 (7.5) | 0.751 | 20.5 (7.75) |
| Gender (F, %) | 85.7 (6) | 69.2 (9) | 100 (2) | 0.51 | 77 (17) |
| ANA positivity, % (n) | 57.4 (4) | 38.4 (5) | 50 (1) | 0.72 | 45 (10) |
| Disease duration at RTX start in years, median (IQR) | 11 (9) | 8 (5) | 27.5 (6.5) | 0.318 | 10 (11.25) |
| DAS28 at starting treatment with RTX, median (IQR) | 3.7 (0.5) | 3.8 (1.02) | 3.4 (0.4) | 0.691 | 3.7 (0.79) |
| DAS28 at 6 months with RTX treatment, median (IQR) | 1.7 (1.05) | 2.19 (1.4) | 2.1 (0.9) | 0.606 | 2.0 (1.35) |
| DAS28 at 12 months with RTX treatment, median (IQR) | 1.82 (1.0) | 2.10 (0.7) | 2.39 (0.6) | 0.691 | 2.0 (0.90) |
| Iridocyclitis, % (n) | 85.7 (6) | 30.7 (4) | 50 (1) | 0.064 | 50 (11) |
| Comorbidities, % (n) | 14.2 (1) | 46.1 (6) | 100 (2) | 0.078 | 40.9 (9) |
| Concomitant MTX, % (n) | 57.1 (4) | 38.4 (5) | 50 (1) | 0.710 | 45.5 (10) |
| N of pre-RTX bDMARDs, median (IQR) | 3 (1.5) | 2 (2.0) | 3 (2.0) | 0.593 | 2 (2.0) |
| Duration of treatment with RTX in years, median (IQR) | 9.71 (9.9) | 7.45 (3.4) | 4.79 (2.1) | 0.623 | 7.2 (5.7) |
| Number of major infections during RTX treatment, median (IQR) | 2 (1) | 2 (1) | 1.5 (0.5) | 0.862 | 2 (1) |
| Hospitalization during RTX treatment, % (n) | 14.3 (1) | 0 (0) | 50 (1) | 0.529 | 9.1 (2) |
JIA: Juvenile Idiopathic Arthritis, IQR: Interquartile Range, MTX: Methotrexate, RTX: Rituximab
LEF: Leflunomide, bDMARDs: biological Disease-Modifying Antirheumatic Drugs, ANA: Antinuclear Antibodies, DAS28: Disease Activity Score 28
Acknowledgements: NIL.
Disclosure of Interests: None declared.