Real-World Use of Rituximab in Rheumatoid Arthritis: A 3-Year Analysis from the RBSMR Biologic Registry

Background Rituximab (RTX) is generally recommended as a second-line biologic therapy in rheumatoid arthritis (RA) according to international guidelines. In Morocco, however, it has often been used as a first-line biologic due to its favorable tuberculosis safety profile, affordability, and intermittent dosing schedule. Objective To assess the safety and efficacy of RTX in RA using data from the Moroccan Society of Rheumatology Biologic Registry (RBSMR). Methods The registry included 224 patients with RA followed every 6 months over 3 years. This analysis focused on those treated with RTX, specifying whether it was used as first- or second-line therapy and documenting re-treatments. Clinical, biological, and radiographic characteristics were described. Safety (hypersensitivity reactions, infections) and efficacy (remission or low disease activity) were the main outcomes. Results The mean age was 51.9 years; 88.2% were female. Mean RA duration was 13 years. Seropositivity was found in 87.1%, erosive disease in 67.8%. The mean DAS28 score was 5.65. Corticosteroids were used in 77% of patients, with methotrexate as the most common csDMARD (47.3%). RTX was administered to 170 patients (75.8%), mostly as first-line biologic. The adverse event rate was 14.3 per 100 patient-years; serious infections occurred at 0.98 per 100. Rates of remission or low disease activity increased from 1.4% at baseline to 45.2% at 12 months. Conclusion RTX showed a favorable safety profile and meaningful clinical efficacy from the first year of treatment, supporting its first-line use in tuberculosis-endemic settings.