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Rituximab reduced atherosclerosis progression in RA patients
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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.”
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