Rituximab (MabThera), currently recommended for patients who have not responded to other treatments, was shown in a landmark trial to halt joint deterioration in people showing the first signs of RA.

This could lead to a 'paradigm shift' in RA treatment where patients are given advanced therapy as soon as they are diagnosed, instead of having to wait until other treatments have been tried.

What is the research?
The randomised controlled trial, presented at the European League Against Rheumatism (EULAR) conference in Copenhagen earlier this month, compared the benefits of rituximab plus methotrexate with methotrexate alone in treating early active RA.

A group of 755 RA patients were assigned to receive either methotrexate plus two 500mg doses of rituximab, methotrexate plus two 1,000mg doses of rituximab, or methotrexate plus placebo.

Compared with the methotrexate plus placebo group, methotrexate plus two doses of rituximab 1,000mg was associated with significantly lower rates of disease progression after 52 weeks.

In addition, rituximab treatment was associated with improved clinical outcomes. Over 64 per cent of patients given rituximab 1,000mg plus methotrexate reported a 50 per cent improvement in symptoms compared to 42 per cent of patients treated with methotrexate alone.

Disease progression in patients offered the lower, 500mg doses of rituximab, however, was not found to be significantly affected.

What do the researchers say?
Lead investigator Professor Paul-Peter Tak from the University of Amsterdam, said: 'These positive data clearly support the use of MabThera earlier in the RA treatment algorithm.

'These robust data add to the wealth of existing evidence for the use of MabThera across a broad range of RA patients, and give us a great new option to prevent joint damage in the early stages of the disease.'

What do other researchers say?

John Isaacs, professor of rheumatology at Newcastle University, agreed that a shift in the treatment of RA was coming.

'We are finding that there is a window of opportunity in RA treatment that occurs early in the course of the disease.

'If we can treat patients with an effective treatment, such as biologics or TNF-blockers at this stage, it can have a very lasting effect on their disease progression and how well they respond to other treatments afterward.'

It is important that GPs continue referring all patients where a diagnosis of RA is suspected, added Professor Isaacs.

GPletters@haymarket.com

• European League Against Rheumatism Conference

Informing Patients

• Rituximab plus methotrexate is better at preventing disease progression in severe RA than methotrexate alone.
• Currently rituximab is recommended for use after other disease modifying agents have been tried and failed.