RItuximab Use in Northern Ireland
Lucy Kayes, Natalie McKee, Elisabeth Ball
Rheumatology Department, Musgrave Park Hosptial, Belfast
Rituximab is a commonly used biologic therapy in rheumatology for a variety of pathologies. This retrospective study examining key demographics of the patient population in Northern Ireland currently receiving riuximab.
The aim was to review the electronic care record of all patients currently receiving rituximab according to the biologic database held within the Belfast Trust. Once data had been collected this would be compared to the recommendations in current NICE guidelines. This should then identify areas for development.
A snapshot of the database was taken in March 2018. The electronic care record of each patient registered on the database as currently receiving rituximab was reviewed and data entered into an annonymous spreadsheet. This included gender, age, diagnosis, previous biologic therapy and DMARD therapy. Data was then analysed in Microsoft Excel.
242 patients included identified, of these 179 were currently receiving rituximab. The most common indication was seropositive rheumatoid arthritis, accounting for 73% of patients. 13 cases had no serological definition of arthritis. 39% of patients were not on a DMARD. However, 57% of patients had been on methotrexate prior to commencing rituximab. In total, only 28 patients had never had methotrexate. The most common biologic used prior to switch to rituximab was adalimumab. In the population identified by the database but not currently receiving rituximab the most common reason for cesation was inefficacy. DAS28 was infrequently recorded. Use of mabthera or truxima (the two formulations of rituximab currently used) was not clearly defined.
Rituximab is used for a variety of rheumatological conditions within Northern Ireland. As recommended by NICE methotrexate was used as DMARD therapy prior to or alongisde biologic therapy unless contraindicated. Poor documentation of DAS 28 scores made efficacy difficult to assess. Improvement of the database and data recording at point of care is required to improve information available for further research, particularly with the introduction of biosimilars.