Rituximab用於類風溼性關節炎之持續治療比率：單一醫學中心之經驗

Rituximab retention rate in rheumatoid arthritis: a single center experience

目的：Rituximab是一種對抗B細胞表面抗原CD20的單株抗體，臨床上可使用在治療類風濕性關節炎。在過去的研究中已經證實其臨床的安全性與療效。本研究分析單一醫學中心在類風溼性關節炎病患使用Rituximab的經驗與停藥原因。方法：自2008年11月至2012年12月在台北榮民總醫院接受第一劑Rituximab的病人接受回溯性的觀察，我們把持續使用Rituximab與停藥的病患分為兩組並記錄停藥原因與病患的臨床表徵，進一步分析兩組之間的差別。結果：69個病患被收錄至此一研究。直到2016年6月，仍有57個病患仍持續使用Rituximab。12個病患中，6個因感染而停藥、4個因藥物無效、2個因腦血管疾病停藥，維持治療的比例為82.6%。年齡、身體質量指數（BMI）、疾病時間長短、ESR、CRP、DAS28、類風濕性因子，目前使用的疾病調節抗風濕藥物與過去使用的生物製劑等因子於持續使用組與停藥組並無統計上的差別，但男性傾向容易停藥（p值=0.034）。結論：在持續四年以上Rituximab治療後其維持治療的比例為82.6%，大多數停藥的原因為感染症。

Objectives: Rituximab (RTX) is a monoclonal anti-CD20 antibody for treating rheumatoid arthritis (RA). Previous studies have shown its efficacy and safety in clinical practice. This study aimed to evaluate RTX treatment and discontinued reasons in RA patients in a single center. Methods: We retrospectively reviewed the RA patients who had received first dose RTX between November, 2008 and December, 2012 at Taipei Veteran General Hospital. These patients had been observed until being discontinued from RTX. The withdrawal causes and patients’ characteristics were recorded and we categorized patients to RTX retention and discontinued groups. Inter-group differences of clinical presentations and laboratory data were analyzed. Results: A total 69 RA patients were enrolled, 57 patients continued to receive cyclic RTX therapy until June, 2016. Twelve patients withdrew from therapy due to infection (6 patients), inefficacy (4 patients) and cerebrovascular accident (2 patients), the drug retention rate was 82.6%. Age, body mass index, disease duration, ESR, CRP, DAS28, RF status, concurrent drugs and previous biologics showed insignificant differences between these two groups, only male (p=0.034) was prone to withdraw from RTX therapy. Conclusion: The total RTX retention rate was 82.6% after at least 4 years treatment. Most patients discontinued from RTX due to infection.