Rituximab fixed retreatment versus on-demand retreatment in refractory rheumatoid arthritis: comparison of two B cell depleting treatment strategies

Rituximab, an anti-CD20 monoclonal antibody, has been approved for treatment in patients with rheumatoid arthritis (RA) who have failed treatment with tumour necrosis factor (TNF) blocking agents.1 Previous studies have demonstrated its safety, efficacy and prevention of radiographic progression;2 3 however few studies have yet addressed the timing of repeated courses of rituximab. A study in 22 patients with RA showed that treatment with repeated courses of rituximab over a 5-year follow-up period was safe and well tolerated4 and additionally an open-label extension study of 3 large randomised, double-blind studies in patients with RA showed that clinical efficacy was maintained with subsequent courses of rituximab, comparable to the first rituximab course, without increased additional safety concerns.5 Interestingly, one …