Rituximab for the treatment of rheumatoid arthritis

Rituximab has been approved by the United States Food and Drug Administration in combination with methotrexate for the treatment of rheumatoid arthritis in patients who failed to achieve adequate benefit from tumor necrosis factor-alpha inhibitors. Rituximab is a biologic agent that depletes peripheral B cells--an action thought to reduce rheumatoid arthritis activity--and induces prolonged clinical improvement. Two 1000-mg infusions administered 2 weeks apart can result in a response that lasts for months. Most patients will require retreatment, but the effect of repeated dosing on patient outcomes has not yet been determined. Combination therapy with methotrexate is recommended as this appears to achieve the best outcomes. Rituximab also has been shown to be safe, although the lack of long-term efficacy and safety data limit its use. More studies are needed, but this agent has been demonstrated to be safe and effective in patients who fail to achieve adequate clinical response to methotrexate and tumor necrosis factor-alpha inhibitors.