Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Statins Inhibit the Anti-Rheumatic Effects of Rituximab in Rheumatoid ArthritisResults from the Dutch Rheumatoid Arthritis Monitoring (DREAM) Registry.
Fransen5, Jaap, Van Riel5, Piet L. C. M., Van de Laar3, Mart A. F. J., Dutmer1, Ellen, Vonkeman3, Harald E., Broeder6, Alfons Den, Jansen2, Tim L.
Gelderse Vallei Hospital Ede
Medical Centre Leeuwarden
Medisch Spectrum Twente & University of Twente
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Radboud University Nijmegen Medical Centre
Rituximab (RTX) is used in the treatment of lymphomas and Rheumatoid Arthritis (RA). In lymphoma studies, it has been suggested that statins may inhibit the efficacy of RTX by impairing its binding to CD20. However, evidence is ambiguous. This study aims to investigate whether in RA, the combination of statins and RTX, compared with RTX alone, reduces its effect on disease activity at 6 months.
All (N=187) RA patients who started on RTX in the DREAM registry were included in this prospective cohort study, 23 patients were exposed to the combination of statins and RTX. The primary outcome was disease activity (DAS28) at 6 months, analyzed using ANCOVA. Power was calculated in advance and exceeded 0.80, a=0.05. The secondary outcome was drug survival of the first RTX course, analyzed using Cox-proportional hazards regression.
Patients exposed to statins were older and more frequently male. Disease duration, ESR, DAS28, rheumatoid factor, previous DMARDS, use of glucocorticoids, and concomitant MTX use did not differ (p>0.05) at baseline. At 6 months DAS28 scores differed significantly (p=0.023) between patients exposed (mean 4.8, SD 1.5) and unexposed (mean 4.3, SD 1.1) to statins. RTX survival was significantly shorter in the exposed group, HR (95%CI) of 2.3 (1.43.9). Baseline DAS28 and rheumatoid factor were included as covariates in all models.
In RA, concomitant use of statins significantly reduces the effect of RTX on disease activity. This lends support to the hypothesis that statins can reduce the clinical effects of RTX, possibly through cholesterol depletion.
To cite this abstract, please use the following information:
Fransen, Jaap, Van Riel, Piet L. C. M., Van de Laar, Mart A. F. J., Dutmer, Ellen, Vonkeman, Harald E., Broeder, Alfons Den, et al; Statins Inhibit the Anti-Rheumatic Effects of Rituximab in Rheumatoid ArthritisResults from the Dutch Rheumatoid Arthritis Monitoring (DREAM) Registry. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1833