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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rituximab for rheumatoid arthritis.

Maria Angeles Lopez-Olivo1, Matxalen Amezaga Urruela, Lynda McGahan

  • 1Department of General Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1465, Houston, Texas, USA, 77030.

The Cochrane Database of Systematic Reviews
|January 21, 2015
PubMed
Summary

Rituximab combined with methotrexate significantly improves rheumatoid arthritis (RA) symptoms and prevents disease progression compared to methotrexate alone. This combination therapy shows greater efficacy and reduced patient withdrawal rates, with manageable adverse events.

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Area of Science:

  • Rheumatology and Immunology
  • Pharmacology and Therapeutics
  • Clinical Trial Analysis

Background:

  • Rituximab is a biologic agent targeting CD20-positive B-cells, used for refractory rheumatoid arthritis (RA).
  • It is considered for patients unresponsive to other biologic disease-modifying anti-rheumatic drugs (DMARDs).
  • Evidence supports rituximab's efficacy and tolerability when combined with methotrexate for RA.

Purpose of the Study:

  • To evaluate the efficacy and safety of rituximab for treating rheumatoid arthritis (RA).
  • To assess benefits and harms of rituximab, alone or with DMARDs, versus placebo or other DMARDs in active RA patients.

Main Methods:

  • Systematic literature search of electronic databases, clinical trial registries, and regulatory agency websites up to January 2014.
  • Inclusion of all controlled trials comparing rituximab (monotherapy or combination) with placebo or other DMARDs in adult RA patients.
  • Independent data abstraction and risk of bias assessment by two review authors.

Main Results:

  • Eight studies (2720 patients) were included; evidence quality was moderate for most outcomes.
  • Rituximab (2x1000 mg doses) plus methotrexate significantly improved ACR 50 response rates (RR 3.3, NNT 6) and clinical remission (RR 2.4, NNT 7) at 24-52 weeks.
  • The combination therapy improved Health Assessment Questionnaire (HAQ) scores (ATB 24%, NNT 5) and reduced radiographic progression (ATB 11%, NNT 10), with improved quality of life scores (SF-36).

Conclusions:

  • Rituximab (2x1000 mg doses) in combination with methotrexate demonstrates significantly greater efficacy than methotrexate alone in improving RA symptoms.
  • This combination therapy is effective in preventing disease progression and improving quality of life for RA patients.
  • While adverse events were more frequent after the first infusion (ARD 9%, NNH 11), serious adverse events did not differ significantly, and patient withdrawal rates were lower.