The initial choice of biologic is crucial to long-term success. Yet there are few studies evaluating head-to-head differences in some of our most popular therapies.

B-cell depletion with Rituximab (RTX) is seldom used as first line treatment in moderate-to-severe RA. This honour belongs to the anti-TNFs. This is mainly because the latter gives fast and good symptoms relief in responders, while RTX typically takes up to 2 months to “kick-in”.
However, it can be just as effective and even more economical in comparison, especially for patients needing longterm biologics for adequate disease control.
As a single infusion every 6 months, it is also more convenient than the weekly/fortnightly/monthly injections, depending on the anti-TNF used.

The results of the PRAIRI study were presented…

I would have thought that deploying Rituximab as first line biologic in moderate-to-severe RA is a tough call to make, considering that symptoms may not respond for a good 2 months, if at all.
Now, brave souls are recommending using it to treat pre-RA (possibly mild symptoms and radiological evidence of inflammation) patients who are “at-risk” owing to their being RF/anti-CCP positive. Well, the PRAIRI study seems to suggest that RTX can delay the onset of full-blown RA.

Treatment of systemic lupus erythematosus with rituximab effectively decreased disease activity with…

Although the 2 large trials failed to demonstrate Rituximab’s superiority compared to conventional treatment for severe SLE, most rheumatologists fall back on RTX when faced with challenging Lupus.
This study vindicates our faith in this drug.

GLASGOW – Rituximab is unlikely to work as a treatment for Sjögren’s syndrome, according to a sneak peak of results from a multicenter study. The study, the Trial…
www.rheumatologynews.com|By SARA FREEMAN

Rituximab is not a panacea. This trial showed no benefit in addressing the fatigue and symptoms of dryness in Sjögren’s Syndrome.
Perhaps B cells are not as central in the pathogenesis of the disease as conventionally thought. T cells and long-lived plasma cells may play important roles, and these cells are not depleted by RTX.

Rheumatology (Oxford). 2016 Jul;55(7):1318-24. doi: 10.1093/rheumatology/kew195. Epub 2016 Apr 8.
www.ncbi.nlm.nih.gov|By Sharp C , et al.

Lung involvement in autoimmune connective tissue diseases like Scleroderma, Lupus and Myositis can be life-threatening, especially if it progresses rapidly and fail to respond to conventional aggressive therapies.
Rituximab again comes to the rescue when all else fails, with myositis-related subsets like the Anti-Synthetase Syndrome responding better than other CTD subsets.

Nearly half of patients on ocrelizumab achieved no evidence of disease activity (NEDA)

Like Rituximab, another B-cell depletion agent called Ocrelizumab is shown to be effective in treating progressive and remitting-relapsing Multiple Sclerosis; perhaps even better than current therapies like the interferon-beta.