Optimizing rheumatoid arthritis treatment with rituximab - individualized patient approach

Praćenje aktivnosti bolesti osnova je u usmjeravanju liječenja reumatoidnog artritisa rituksimabom (RTX). Uz praćenje kliničkih znakova i biomarkeri (RF i anti-CCP) mogu rano usmjeriti liječenje i ukazati na vjerojatan terapijski odgovor. Seropozitivnost (RF i/ili anti-CCP) povezani su dobrim odgovorom na liječenje s RTX u bolesnika koji nisu imali odgovarajući odgovor na anti-TNF lijek i DMARD te u bolesnika koji nisu liječeni metotreksatom (MTX). U odabiru lijeka za bolesnike koji nisu imali odgovarajući odgovor na anti TNF lijekove treba uzeti u obzir rezultate recentnih publikacija. One ukazuju da se u takvih bolesnika liječenih s RTX postiže značajno poboljšanje DAS8 u odnosu na liječenje novim anti-TNF lijekom. Recentne NICE smjernice preporučuju primjenu RTX u kombinaciji s MTX nakon izostanka odgovarajućeg odgovor na anti TNF lijek umjesto ponovne primjena novog antiTNF lijeka.Disease activity assessment is a cornerstone of monitoring rheumatoid arthritis (RA) development and guidance for rituximab treatment. Beside clinical signs and symptoms biomarkers (RF and anti-CCP) are important early predictors of response to therapy and they can predict disease development. Autoantibody (RF and anti-CCP) seropositivity has been associated with positive response to rituximab (RTX) in antiTNF-IR patients, DMARD-IR patients and MTX-naive patients. Selecting therapy for TNF-IR patients providing most likely response it should be taken in consideration results form recently published assessments demonstrating for RTX treated patients significant improvement in DAS28 from baseline versus alternative TNF inhibitor treatment. Recently published NICE treatment guideline is recommending upon antiTNF failure RTX treatment (in combination with MTX) instead antiTNF cycling