Background/Aims Rituximab was originally developed as a non-Hodgkin lymphoma treatment and rheumatology adopted the same dosing for rheumatoid arthritis(RA); two 1000mg doses two weeks apart for each maintenance cycle. UHSussex utilises self-referral for maintenance rituximab dosing once disease control lessens. Evidence demonstrates patients treated with lower dose rituximab still enjoy good disease control with less immunosuppression, reduced hospital attendance and reduction in drug expenditure. Following one two-dose cycle, stable RA patients were prescribed a single 1000mg dose from 2020 onwards. A retrospective outcome analysis was completed in August 2022; however, results were highly impacted by Covid-19 and a repeat analysis was required. Aim: to assess impact of a single 1000mg dose rituximab regime on patient sustained outcomes, dose intervals, Disease Activity Scores (DAS) and drug expenditure. Methods The pharmacy database was used to identify RA patients receiving rituximab from March 2020 to August 2023. Patients received at least one standard two-dose cycle before switching to a single infusion. Patients were excluded if lost to follow up (under care of rheumatology for less than a year following dose switching) or considered clinically unstable. Patient letters and departmental records were accessed for disease scores and treatment intervals. Results Table1: Results from the two analysis periods From the original cohort (31/59)53% remained on single dosing. Switch back tended to occur within 18 months of switching. DAS scores were not collected reliably and were omitted. Conclusion Covid-19 impacted services and attitudes during the initial study period. Many patients stopped treatment, particularly rituximab, due to the prolonged duration of effect, excluding them from analysis. The dose-interval increase during the first analysis was considered a result of the pandemic. Patients and clinicians delayed infusions; minimising immunosuppression due to perceived increased risk of Covid-19. The continued interval increase in the second analysis may identify a patient cohort in deep remission eligible for therapy review. The study highlights poor practice in collecting and recording DAS scores and appropriate patient-clinician interaction opportunities. 53% of patients remained on single infusions in August 2023 resulting in resource savings, reduced hospital attendance, immunosuppression and significant cost savings demonstrating the rationale for this option. Disclosure S. Butler: Honoraria; Abbvie, Janssen. H. Smith: Honoraria; Novartis, Abbvie.

中文翻译：

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E054 类风湿关节炎中利妥昔单抗剂量最小化，回顾性结果分析

背景/目的 利妥昔单抗最初是作为非霍奇金淋巴瘤治疗药物而开发的，风湿病学采用与类风湿性关节炎（RA）相同的剂量；每个维持周期间隔两周两次 1000mg 剂量。一旦疾病控制减弱，UHSussex 就会利用自我转介来维持利妥昔单抗剂量。有证据表明，接受较低剂量利妥昔单抗治疗的患者仍然享有良好的疾病控制，免疫抑制较少，住院人数减少，药物支出减少。在一个两剂周期后，从 2020 年起，稳定的 RA 患者将接受单次 1000 毫克剂量的治疗。回顾性结果分析于 2022 年 8 月完成；然而，结果受到 Covid-19 的严重影响，需要重复分析。目的：评估单次 1000 毫克剂量利妥昔单抗治疗方案对患者持续结局、剂量间隔、疾病活动评分 (DAS) 和药物支出的影响。方法 使用药房数据库来识别 2020 年 3 月至 2023 年 8 月期间接受利妥昔单抗的 RA 患者。患者在转为单次输注之前至少接受一个标准的两剂量周期。如果患者失访（剂量转换后接受风湿病治疗不到一年）或被认为临床不稳定，则患者被排除。查阅患者信件和部门记录以了解疾病评分和治疗间隔。结果表 1：两个分析期的结果 原始队列 (31/59) 53% 仍坚持单次给药。转换回来往往会在转换后 18 个月内发生。 DAS 分数未可靠收集并被忽略。结论 Covid-19 在初始研究期间影响了服务和态度。许多患者由于疗效持续时间较长而停止治疗，尤其是利妥昔单抗，因此将他们排除在分析之外。第一次分析期间剂量间隔的增加被认为是大流行的结果。患者和临床医生延迟输注；由于认为 Covid-19 风险增加，最大限度地减少免疫抑制。第二次分析中间隔时间的持续增加可能会识别出符合治疗审查资格的深度缓解患者队列。该研究强调了收集和记录 DAS 评分以及适当的患者与临床医生互动机会方面的不良做法。 2023 年 8 月，53% 的患者仍接受单次输注，从而节省了资源、减少了就诊人数、免疫抑制并显着节省了成本，证明了这一选择的合理性。披露 S. Butler：酬金；艾伯维，詹森。 H. 史密斯：酬金；诺华、艾伯维。