Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Rituximab Versus Anti-TNF in Patients Who Previously Failed One or More Anti-TNFs in An Observational Cohort: The SARASTRA Study

Chatzidionysiou,  K., Carli,  C. C., van Vollenhoven,  R. F.


Rituximab (RTX) is mostly used after the failure of at least one anti-TNF. Another option is to switch to another anti-TNF, and it is not yet clear which of these two options is the more successful strategy. The purpose of this study was to determine if patients who failed one or two anti-TNFs achieve better results when switching to another anti-TNF or when switching to RTX and find potential correlation between reason of discontinuation and efficacy of next treatment.


The Stockholm registry "STURE" was used. Treatment results at 3 and 6 months were analyzed by: 1) biologic used; 2) whether as second or third biologic; 3) reason of discontinuation of the first or second agent (inefficacy or intolerance). Treatment segments with anakinra were disregarded for this analysis; of duplicate segments with the same anti-TNF only the first one was used.


A total of 479 patients switched to a second biologic therapy. 229 of them (47.8%) discontinued their first agent because of inefficacy and 141 (29.4%) because of intolerance. The rest of the patients stopped for other reasons. When used as the 2nd biologic RTX achieved highly significant reductions from baseline in DAS28 at 3 and at 6 months (p<0.001); these changes were numerically but not significantly greater than the change that occurred in patients who switched to another anti-TNF. The subgroup of patients who switched to RTX because of intolerance to the first anti-TNF agent had better response and a higher percentage of them achieved EULAR good/moderate response compared to those who switched to a second anti-TNF after they had not tolerated a first one (table 1).

Table 1. Improvement in DAS28 and EULAR good/moderate response for patients receiving RTX or an anti-TNF agent according to the reason of discontinuation of their previous biological treatment.

  2nd biologic3rd biologic
Biologic usedReason of discontinuation of previous therapyN of patientsDDAS28 0–6m (mean±SD)EULAR good/moderate resp at 6 mN of patientsDDAS28 0–6m (mean±SD)EULAR good/moderate resp at 6 m

153 patients switched to a third biologic. The reductions in DAS28 are similar for patients on RTX and an anti-TNF, but numerically higher for those patients on RTX who showed intolerance to a previous TNF antagonist (table 1). Intolerance to the 2nd anti-TNF strongly predicts good response to therapy with RTX when used as third biologic (p=0.007). Higher disease activity at baseline was found to be associated with a higher risk of discontinuation of treatment (p<0.0001).


In patients who failed one anti-TNF, RTX yields results that are as good as, and in some comparisons numerically better than, switching to another anti-TNF. For patients who previously did not tolerate an anti-TNF agent RTX seems to be a better alternative.

To cite this abstract, please use the following information:
Chatzidionysiou, K., Carli, C. C., van Vollenhoven, R. F.; Rituximab Versus Anti-TNF in Patients Who Previously Failed One or More Anti-TNFs in An Observational Cohort: The SARASTRA Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1025
DOI: 10.1002/art.26102

Abstract Supplement

Meeting Menu