Sustained Remission After Combination Therapy with Rituximab and Etanercept in Two Patients with Rheumatoid Arthritis After TNF Failure: Case Report
Martin Feuchtenberger*, Christian Kneitz, Petra Roll, Stefan Kleinert, Hans-Peter Tony
University of Würzburg, Dept. of Medicine II, Rheumatology and Clinical Immunology, Germany; Department of Medicine II, Klinikum Südstadt Rostock, Germany
Approximately up to 40% of patients with rheumatoid arthritis (RA) fail to respond to tumor necrosis factor (TNF) inhibitors, lose response over time or are unable to tolerate treatment.
Materials and Methodology:
We report two female patients suffering from active, refractory rheumatoid arthritis despite TNF blocking agents who have been treated with rituximab added to ongoing therapy with etanercept.
Combination therapy was tolerated without any acute side effects. Both patients improved with a significant, long lasting reduction of disease activity (DAS28, CRP). Evaluation of the immunological parameters showed the expected B-cell depletion and a transient reduction of immunoglobulin-levels. One patient developed four serious infections requiring antibiotic treatment (1 pneumonia, 3 exacerbations of her pre-existing chronic bronchitis) within follow up of 45 months.
Combination therapy of rituximab and etanercept lead to a significant improvement of clinical disease activity and inflammatory parameters in two RA patients refractory to anti-TNF treatment.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the University of Würzburg, Dept. of Medicine II, Rheumatology and Clinical Immunology, Klinikstraße 6, D-97070 Würzburg, Germany; Tel: 49-(0)931/201-0; Fax: +49-(0)931/201-70421; E-mail: Feuchtenbe_M@klinik.uni-wuerzburg.de