Efficacy and safety of rituximab versus leflunomide in Sri Lankan patients with rheumatoid arthritis ?

Rituximab infusions

1.18-65 years of age 2. must fulfill the revised 1987 American Rheumatism association criteria for at least 6 months 3.Swollen joint count ³4 (28 joint count) and tender joint count ³4(28 joint count at screening and baseline 4.CRP ³6 mg/L OR ESR ³28 mm/h at screening 5. Patients who used methotrexate at 15-25 mg/wk for at least 12 weeks without response. This will include patients who failed to respond to additional treatment with either or both SSZ, chloroquine. patients who have used leflunomide will not be included 6.The doses of MTX must be stable for 4 weeks prior to baseline 7.Prednisolone <10 mg/day or equivalent glucocorticoids are permitted if dose stable for 4 weeks prior to baseline 8.Patients will be allowed to receive non-steroidal anti-inflammatory drugs if dose stable for ³4weeks prior to baseline 9.A negative serum pregnancy test at screening for female subjects of childbearing potential. Use of contraception in patients of reproductive potential

• History of or current inflammatory joint disease other than RA or other systemic rheumatic disorder • Patients with functional class IV according to ACR classification of functional status • Known hypersensitivity to any component of the tetanus toxoid adsorbed vaccine • Evidence of significant uncontrolled concomitant disease, such as diseases of heart, liver, lung, nervous system, renal, endocrine, or gastrointestinal disorders • Known active bacterial, viral, fungal, mycobacterial, or other infection or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of Day 1 or oral antibiotics within 2 weeks of Day 1 • History of serious recurrent or chronic infection history of deep space/tissue infection within 52 weeks prior to baseline. History of or currently active primary or secondary immunodeficiency, including HIV infection • History of cancer, including solid tumors and hematological malignancies • History of alcohol, drug, or chemical abuse within the 6 months prior to screening • Diagnosis of juvenile idiopathic arthritis/juvenile rheumatoid arthritis before age 16 • Immunization with a live vaccine within 4 weeks prior to randomization (Day 1) • Serum creatinine > 1.4 mg/dl for women or > 1.6 mg/dl for men • AST or ALT > 2.5 times upper limit of normal • Platelet count < 100,000/ml • Hemoglobin < 8.0 g/dl • Neutrophils < 1.5x10^3/ml • Positive tests for hepatitis B surface antigen • Levels of IgG < 5.0 mg/ml and/or IgM = 0.4 mg/ml