What are Rheumatoid Arthritis (RA) infusions?

From the Guidelines

Rheumatoid arthritis (RA) infusions should prioritize tocilizumab (Actemra) at 4-8 mg/kg every 4 weeks, given its rapid and sustained improvement in clinical and radiographic outcomes and health-related quality of life, as established by extensive clinical experience and studies 1. When considering RA infusions, it is essential to evaluate the various biologic medications available, each targeting specific components of the immune system. The most commonly used infusion therapies include:

• Tocilizumab (Actemra) at 4-8 mg/kg every 4 weeks
• Abatacept (Orencia) at weight-based dosing (500-1000 mg) given at weeks 0,2, and 4, then monthly
• Rituximab (Rituxan) at 1000 mg given two weeks apart every 6 months Before starting infusions, patients should undergo screening for tuberculosis, hepatitis B and C, and have baseline laboratory tests including complete blood count and liver function tests. During treatment, regular monitoring for infections and adverse effects is essential, as recommended by the European League Against Rheumatism (EULAR) 1. Key considerations in choosing an infusion therapy include individual patient factors, such as comorbidities, prior treatment response, and insurance coverage. Infusions are typically administered in specialized infusion centers with medical supervision to monitor for infusion reactions. The EULAR recommendations provide consensus on the management of RA, emphasizing the importance of treat-to-target strategies and the use of biologic DMARDs, such as tocilizumab, in patients with moderate to severe active RA 1.

From the FDA Drug Label

1. 5 Recommended Dose for Rheumatoid Arthritis (RA) Administer RITUXAN as two-1,000 mg intravenous infusions separated by 2 weeks. Glucocorticoids administered as methylprednisolone 100 mg intravenous or its equivalent 30 minutes prior to each infusion are recommended to reduce the incidence and severity of infusion-related reactions Subsequent courses should be administered every 24 weeks or based on clinical evaluation, but not sooner than every 16 weeks. RITUXAN is given in combination with methotrexate.

For Rheumatoid Arthritis (RA) infusions, the recommended dose of RITUXAN is two 1,000 mg intravenous infusions separated by 2 weeks, with glucocorticoids administered 30 minutes prior to each infusion to reduce infusion-related reactions. Subsequent courses should be administered every 24 weeks or based on clinical evaluation, but not sooner than every 16 weeks, in combination with methotrexate 2.

• Key points:
  • Dose: two 1,000 mg intravenous infusions
  • Interval: separated by 2 weeks
  • Combination therapy: with methotrexate
  • Glucocorticoids: administered 30 minutes prior to each infusion
  • Subsequent courses: every 24 weeks or based on clinical evaluation, but not sooner than every 16 weeks

From the Research

RA Infusions

• RA infusions, such as rituximab, abatacept, and tocilizumab, are effective in treating rheumatoid arthritis (RA) in patients with active disease who have not responded to at least one disease-modifying antirheumatic drug (DMARD) 3
• Rituximab, in combination with methotrexate, has been shown to be effective in improving symptoms of RA and preventing disease progression, with a significant improvement in American College of Rheumatology (ACR) 50 response rates and clinical remission rates 4
• The use of rituximab, abatacept, and tocilizumab as a first-line biological agent may be considered, with tocilizumab having a practical advantage of being administered as a first-line biological agent 3
• Adverse events, including infusion reactions, are common with RA infusions, but the risk of serious infections appears to be similar to that with TNF inhibitors 3

Treatment Strategies

• The choice of RA infusion treatment strategy is based on patient-specific criteria, including disease activity, comorbidities, and patient preferences 5
• A "trial-and-error" approach is often used in RA treatment, with a substantial proportion of patients showing failed therapy for each DMARD 6
• Precision medicine may provide a highly individualized and tailored approach for disease management, with the introduction of various cutting-edge technologies and big data 6
• The retention rate of a second-line biologic DMARD after failure of a first-line therapy with abatacept, tocilizumab, or rituximab may be higher with agents having a different mechanism of action compared to TNF inhibitors 7

Efficacy and Safety

• Rituximab, abatacept, and tocilizumab have been shown to be effective in treating RA, with a good retention rate also when used as a second-line therapy 7
• The efficacy and safety of RA infusions may vary depending on the specific agent and patient population, with a need for further studies to evaluate the most appropriate therapeutic strategies 7
• The risk of adverse events, including infusion reactions and serious infections, should be carefully considered when using RA infusions, with a need for continuous postmarketing surveillance 3