VARIAR Study: Assessment of short-term efficacy and safety of rituximab compared to an tumor necrosis factor alpha antagonists as second-line drug therapy in patients with rheumatoid arthritis refractory to a first tumor necrosis factor alpha antagonist

Reumatol Clin. Nov-Dec 2016;12(6):319-322. doi: 10.1016/j.reuma.2015.11.019. Epub 2016 Jan 29.
[Article in En, Spanish]


Objective: to compare the short-term efficacy and safety of rituximab (RTX) therapy versus anti-TNF in rheumatoid arthritis (RA) patients after discontinuation of a first anti-TNF agent.

Methods: prospective observational multicenter study in the clinical practice setting, involving patients with severe RA refractory to a first anti-TNF agent, who received either RTX or a second anti-TNF (2TNF), comparing the efficacy endpoints, EULAR response (Good/Moderate) and safety at 6 months.

Results: 103 patients enrolled, 82 completed 6-month follow-up, 73.7% women. Baseline data for RTX and 2TNF groups, respectively: TJC, 8.6 and 6.6; SJC, 8.8 and 7.5; DAS28 score, 5.45 (±1.28) and 5.18 (±1.21) (p=0.048), ESR, 41 and 38.7mmHg; and HAQ, 1.2 and 1.0. Improvement was observed in all parameters, with no significant differences (except for a more marked reduction in ESR with RTX). There were no serious adverse events.

Conclusions: RTX use as second-line therapy after anti-TNF failure led to improvements in the efficacy and functional variables at 6 months, with no serious adverse events. These results were comparable to those observed in patients who used a second anti-TNF agent in the same clinical scenario.

Keywords: Anti-TNF-alfa; Anti-TNF-alpha; Artritis reumatoide; Rheumatoid arthritis; Rituximab.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Adalimumab / therapeutic use*
  • Adult
  • Aged
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Etanercept / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Infliximab / therapeutic use*
  • Male
  • Middle Aged
  • Prospective Studies
  • Rituximab / therapeutic use*
  • Treatment Outcome


  • Antirheumatic Agents
  • Rituximab
  • Infliximab
  • Adalimumab
  • Etanercept