Call to switch arthritis treatment

New research supports guidance on the treatment of rheumatoid arthritis which is not being followed by some doctors.

Evidence shows that switching from one type of drug to another can help patients at an advanced stage of the disease.

Currently, these patients are given TNF inhibitors, which block the action of an inflammatory signalling molecule called tumour necrosis factor.

When one anti-TNF agent fails the normal practice is to try another - a process known as "cycling".

Preliminary guidance from the NHS watchdog the National Institute for Health and Clinical Excellence (Nice) has now advised against this strategy. It says TNF inhibitor treatment should be halted and patients switched to a different class of drug instead.

However, some doctors are reported to be unwilling to change their treatment approach.

The new study results support the Nice guidance. They show that when patients stop responding to a TNF inhibitor it is more effective to treat them with the antibody drug MabThera than with another anti-TNF therapy.

MabThera, the drug rituximab, works in a completely different way by targeting specific immune system cells involved in RA.

The trial was conducted among 300 patients in the UK and Switzerland. Half were given MabThera and half a different anti-TNF drug. After six months, disease activity - including swollen joints, fatigue and pain - was almost 50% less in the MabThera patients.

The findings were presented at the annual meeting of the European League Against Rheumatism in Paris. One of the researchers, Professor Rob Moots, from Aintree University Hospitals, said: "These findings confirm that switching to an alternative biological agent, such as rituximab, in the subset of RA patients who don't respond to a first anti-TNF agent, can provide major benefits."

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