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42. Kongress der Deutschen Gesellschaft für Rheumatologie, 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 24. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

17.-20. September 2014, Düsseldorf

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Combined therapy with rituximab and NSAIDs in treatment of active ankylosing spondylitis: better than NSAIDs alone, worse than combination of TNF-inhibitors and NSAIDs

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  • Svetlana Lapshina - Kazan State Medical University, Kazan, Russia
  • L. Myasoutova - Kazan State Medical University, Kazan, Russia

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 42. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 24. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Düsseldorf, 17.-20.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc45.02 - FA.20

doi: 10.3205/14dgrh020, urn:nbn:de:0183-14dgrh0202

Published: September 12, 2014

© 2014 Lapshina et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Several reports have shown that rituximab may have some efficacy in patients with active ankylosing spondylitis (AS), mainly in tumor necrosis factor alpha (TNF-α) inhibitor naïve. No direct comparisons of rituximab and TNF-α inhibitors or non-steroid anti-inflammatory drugs (NSAIDs) are published.

Purpose-To directly compare the effect of NSAIDs monotherapy and combinations of NSAIDs with rituximab and TNF-α inhibitors in patients with highly active AS in a prospective study.

20 patients (males-17, mean age 36.3±9.9 years) with highly active AS (BASDAI 6.19±1.48, ASDASESR 3.43±0.72) were treated with rituximab (two infusions, 500-1000 mg depending on body weight and AS activity, separated by 14 days gap) which was added to previously taken NSAID. 35 patients (males-30, mean age 34.3±8.6 years, BASDAI 5.59±1.19, ASDASESR 3.22±0.74) received treatment with combination of TNF-α inhibitors (infliximab, etanercept, adalimumab) and NSAIDs. 35 patients (males-30, mean age 33.4±9.3 years, BASDAI 5.95±1.26, ASDASESR 3.32±0.60) received monotherapy with NSAIDs. Share of AS patients who achieved ASAS 20 response on week 24 was the primary endpoint.

At week 24, in NSAIDs group mean BASDAI score was 5.22±1.14, with 11 (31.4%) patients satisfying the ASAS 20 response criteria. In rituximab group, mean BASDAI score was significantly lower compared to NSAIDs group (3.70±0.91, p <0.05), 15 (75%) patients reached ASAS20 response. Mean BASDAI score in patients treated with TNF-α inhibitors was the lowest (2.03±0.64) compared both to NSAIDs (p <0.05) and rituximab (p <0.01), with 33 (94.3%) patients achieving ASAS20 response.

Combined therapy with NSAIDs and rituximab is more effective in treating active AS than NSAIDs alone, but less effective compared to combination of NSAIDs and TNF-α inhibitors.