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TREATMENT OF TNF a-NAÏVE PATIENTS WITH POOR PROGNOSIS RHUEMATOID ARTHRITIS USING RITUXIMAB:

TREATMENT OF TNF a-NAÏVE PATIENTS WITH POOR PROGNOSIS RHUEMATOID ARTHRITIS USING RITUXIMAB: A PILOT STUDY EVALUATING SYNOVIAL OUTCOMES Corrie Billedeau, Lead Consumer Dr. El-Gabalawy, Researcher, University of Manitoba Winnipeg, Manitoba. Methods. Objectives.

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TREATMENT OF TNF a-NAÏVE PATIENTS WITH POOR PROGNOSIS RHUEMATOID ARTHRITIS USING RITUXIMAB:

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  1. TREATMENT OF TNF a-NAÏVE PATIENTS WITH POOR PROGNOSIS RHUEMATOID ARTHRITIS USING RITUXIMAB: A PILOT STUDY EVALUATING SYNOVIAL OUTCOMES Corrie Billedeau, Lead Consumer Dr. El-Gabalawy, Researcher, University of Manitoba Winnipeg, Manitoba Methods Objectives • To determine the effects of Rituximab treatment on the synovial tissue (soft tissue that lines the surfaces within the joint cavities) in TNF a-naïve patients (patients that have not been on any tumor necrosis factor medication) with early Rheumatoid Arthritis. • To explore patients perceptions of disease prognoses in early Rheumatoid Arthritis. • Patients with active R.A. who are TNF a- naïve will be given Rituximab 1000 mg x2. • Initially and at 24 weeks the following clinical assessments and blood work-ups was completed: • Joint counts • Patient global • ESR • CRP • HAQ- DI • DAS calculated • An initial synovial biopsy of the most affected knee will be taken and analyzed by immunohistology and gene expression and profiling. This is repeated at the 24 week mark as well. Results Rituximab depletes peripheral B cells more effectively than synovial B cells therefore there is less swelling and hopefully less damage done to the joints and body. Patients are “delighted at feeling so well and hopeful” about their future. The Results Raised More Questions? By depleting B cells early in the disease can the body be “reset” to exclude the auto-reactive chain? Is the response to Rituximab dependent on the presence of B cells in the synovial and their depletion? Change in number of CD22 B cells in serial synovial tissue samples of individual patients. Vos, K. Arth Rheum March 2007 Conclusions The study is still ongoing and looking for new patients. We have learned that recruiting patients for biopsy studies is difficult. Dutch patients seem to be more biopsy receptive. Our Dutch colleagues are now giving their autoantibody positive, pre-R.A. “patients” Rituximab treatment. Acknowledgements Thank you to CAN and Roche for funding. Special Thanks to Dr. Walid Mourad, Dr. Fawzi Aoudjit, Dr. David Boyle, Dr. Marv Fritzler, Dr. Brenda Elias and Dr. El Gabalawy for all of your time and dedication to finding a cure for this disease. Corrie Billedeau, Canadian Arthritis Network, Emeritus Member of Consumer Advisory Council ( e-mail billedeau@mymts.net)

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