Add Rituximab to Methotrexate in RA?

Schattner A. ACP Journal Club. Review: In rheumatoid arthritis, adding rituximab to methotrexate improves clinical outcomes. Ann Intern Med.16 June 2015;162(12):JC9. doi:10.7326/ACPJC-2015-162-12-009

This is a review of -- and commentary on -- the Cochrane review, Rituximab for rheumatoid arthritis.

Cochrane concluded that adding rituximab to methotrexate improved outcomes in rheumatoid arthritis, without increasing adverse effects.

Cochrane had a robust methodological approach, Ami Schattner says. However, the level of evidence was moderate and confidence intervals were wide. Among the limitations:

. Patients in clinical practice differ from those in clinical trials.

. Long-term safety is unknown.

. The optimal dose is unknown, and lower dosages of rituximab may be possible.