Rituximab Shows Superior Durability Over Second TNF Inhibitors in Post-Failure RA Treatment
A new analysis published in Rheumatology, from the RHUMADATA registry suggests that switching to a non–TNF inhibitor (TNFi) advanced therapy—particularly rituximab—after failure of a first TNFi offers superior long-term treatment sustainability in patients with rheumatoid arthritis (RA).
The study followed 611 patients with moderate to severe RA who experienced failure of an initial TNFi. Of these, 320 were prescribed a second TNFi, while 291 switched to an alternative mechanism of action (OMA), such as rituximab. The primary outcome was time to treatment discontinuation.
Median drug retention was notably longer for OMAs compared to second TNFi therapies: 4.48 years versus 2.84 years, respectively. Multivariable analysis demonstrated that patients who switched to an OMA had a significantly lower risk of discontinuation than those who stayed within the TNFi class (adjusted hazard ratio [adjHR] 0.65; 95% CI, 0.44–0.94).
The advantage was particularly pronounced for rituximab. In stratified analysis, rituximab showed the highest treatment persistence with an adjHR of 0.39 (95% CI, 0.18–0.84) when compared to a second TNFi.
“These findings suggest that switching to a therapy with a different mechanism of action is more effective in sustaining long-term treatment than repeating a TNFi,” the authors stated.
The results remained consistent across multiple models, including those adjusted for propensity scores to account for patient selection bias.
“Switching to an OMA, especially rituximab, in patients with failure to a first TNFi appears to be the best strategy as a second line of therapy,” the study concluded.
For clinicians managing patients with RA, this study provides critical real-world evidence supporting the consideration of OMAs—rather than a second TNFi—following initial TNFi failure. The findings may inform shared decision-making and therapeutic sequencing in the evolving treatment landscape of RA.
Reference
Choquette D, Haraoui B, Movahedi M, et al. Which advanced treatment should be used following the failure of a first-line anti-TNF in patients with rheumatoid arthritis? 15 years of evidence from the Quebec registry RHUMADATA. Rheumatology (Oxford). 2025;64(3):1084-1091. doi:10.1093/rheumatology/keae283
