Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

New research published in The Lancet shows that tocilizumab is a more effective treatment than rituximab for rheumatoid arthritis patients with a poor response to anti-tumour necrosis factor (TNF).

Anti-TNF drugs have dramatically improved the lives of many patients living with rheumatoid arthritis. Not all patients respond to therapy however, with almost 40% showing a poor response to treatment.  

An alternative treatment to anti-TNF is the targeting of B-cells which are known to contribute to the development of RA by driving synovial inflammationThe B-cell depleting drug rituximab is used after an inadequate response to initial anti-TNF, but in this more therapy-resistant patient cohort, rituximab also shows limited improvement. The research team hypothesised that the number or markers of synovial tissue  B-cells before treatment could be used to predict a response.  

Peter Taylor, the Norman Collisson chair of musculoskeletal sciences at NDORMS said: We wanted to test the levels of B-cells in synovial tissue from patients with rheumatoid arthritis to see whether low or absent levels of the cells were preventing rituximab from working effectively. Against this we wanted to test whether tocilizumab, which works by inhibiting the action of IL-6, protein that can cause inflammation and damage, improved clinical outcomes. Our study was the first biopsy-driven randomised clinical trial in rheumatoid arthritis.” 

The study was a 48-week, biopsy-driven trial done in 19 centres across five European countries. Following a baseline synovial biopsy, patients were classified as B-cell poor or rich, then randomly assigned to receive either rituximab or tocilizumab infusions.  

To enhance the accuracy of the classification of B-cell poor and B-cell rich patients, baseline synovial biopsies from all participants were subjected to RNA sequencing and reclassified by B-cell molecular signature. At 16 weeks, any improvement in Clinical Disease Activity Index was measured in all patients.  

In the synovial biopsies classified as B-cell poor with RNA sequencing the tocilizumab group had a significantly higher response rate compared with the rituximab group.  

“Our trial represents a milestone towards precision rheumatology,” said Peter. “In future, binvestigating disease at the tissue level we can start to tailor our treatment and make the best drug selection for each individual patient’s needs. This may improve clinical response and have a major effect on related health and societal costs while reducing patient exposure to potentially toxic drugs. 

Similar stories

NDORMS researchers awarded for Dupuytren research

Awards Hand Kennedy Main

Three NDORMS researchers have received awards from the International Dupuytren Society, a patient organisation that brings together Dupuytren Disease patient societies from across the world.

A new study maps the expression of innate immune receptors during the course of arthritis

Arthritis Kennedy Main

The research, which was a collaboration with researchers from Oxford University and Queen Mary University of London and published in Journal of Autoimmunity, looked at changes in receptors known as toll-like receptors (TLRs) in arthritis at different stages of disease.

International Women's Day

Department Main

It’s International Women's Day! This year’s theme is #Choosetochallenge. We’re celebrating some of the amazing women at NDORMS, and asking them what changes they’d like to see in medical sciences over the next 100 years.

Patients and carers invited to join new group helping to shape research and treatment of bones, muscles and joints

Main PPI

Oxford’s newest patient partner group, OPEN ARMS launches today to explore the causes, treatment and care for patients with musculoskeletal conditions. Its first three patient partners explain why they are involved and invite other members of the public to join the team.

NDORMS academics named NIHR Senior Investigators

Main

Congratulations to Professor Jonathan Rees who has been announced as a National Institute of Health Research (NIHR Senior Investigator).

New centre aims to help companies conduct more efficient trials

Botnar Main Trials

A new clinical therapeutics centre has been set up by the University of Oxford to help life sciences companies identify interventions that have the greatest potential to deliver patient benefit, and so bring down the cost of early phase clinical trials.