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Long-Term Safety of Rituximab in Rheumatoid Arthritis: Analysis From the SUNSTONE Registry

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Winthrop KL1, Saag K2, Cascino MD3, Pei J3, John A3, Jahreis A3, Haselkorn T3, Furst DE4. Arthritis Care Res (Hoboken). 2018 Oct 8. doi: 10.1002/acr.23781. [Epub ahead of print]


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1 Oregon Health & Science University, Portland, OR.

2 University of Alabama at Birmingham, AL.

3 Genentech, Inc, South San Francisco, CA.

4 University of California, Los Angeles, Los Angeles, CA.


OBJECTIVE: To evaluate the long-term safety of rituximab in an observational cohort of patients with rheumatoid arthritis (RA) who had an inadequate response to ≥ 1 antitumor necrosis factor therapies in the United States (SUNSTONE Registry).

METHODS: In this prospective, observational cohort study, patients received rituximab according to their physician's standard practice and were evaluated at standard-of-care follow-up visits at least every 6 months. The primary outcome was the incidence of protocol-defined significant infections. Secondary outcomes included serious adverse events potentially associated with rituximab, cardiovascular or thrombotic (CVT) events, seizures, deaths and pregnancies. Posthoc analyses assessed outcomes by concomitant medication use.

RESULTS: Overall, 989 patients (safety-evaluable population) received ≥ 1 dose of rituximab, with a total follow-up of 3844 patient-years (PYs; mean duration, 3.9 years). In total, 341 significant infections occurred in 197 patients (19.9%). The incidence rates (95% CI) for significant infections, CVT events, and seizures were 8.87 (7.98, 9.86), 1.95 (1.56, 2.45), and 0.18 (0.09, 0.38) per 100 PYs, respectively. The incidence of significant infections did not increase with time or with cumulative rituximab exposure. During the study, 64 patients died (crude mortality [95% CI]: 1.66 per 100 PYs [1.30, 2.13]). The most common causes of death were infections (19 patients), malignancy (14), and cardiovascular events (13). Eight pregnancies were reported in 7 patients.

CONCLUSION: In patients with RA treated with rituximab for up to 5 years, the rates of significant infections were stable over time and higher in patients who received long-term systemic steroid treatment.