Efficacy of anti-CD20 treatment in patients with rheumatoid arthritis resistant to a combination of methotrexate/anti-TNF therapy.

• Rheumatoid arthritis (RA) is characterized by chronic joint inflammation and destruction. B cells play important role in modulating immune responses in RA. In the present study we assessed the impact of the B cell targeting as a third line treatment option. Forty-six patients with established erosive RA non-responding to combination treatment with DMARDs and TNF-alpha inhibitors were treated with anti-CD20 antibodies (rituximab). Rituximab was given intravenously once weekly on four occasions. All patients continued with the previous DMARD. Patients were followed by DAS28, levels of circulating B cells, frequency of immunoglobulin-producing cells, immunoglobulins, and rheumatoid factor levels during the period of 12-58 months. Clinical improvement was achieved in 34 of 46 patients (73%) supported by a significant reduction in DAS28 (from 6.04 to 4.64, P < 0.001). Infusion of rituximab resulted in the elimination of circulating B cells in all but one patient. Within 12 months follow-up, B cells returned to circulation in 86% of patients. Fifty-three percent of the patients were successfully retreated with rituximab or re-started with anti-TNF-alpha treatment. Of the 11 non-responders, five were retreated with anti-CD20 within 2 months, four of them with success, four patients received TNF-alpha inhibitors, the remaining two patients received an additional DMARD. Most of the RA patients resistant to TNF-alpha inhibitors may be effectively treated with anti-CD20 antibodies. The treatment is well tolerated and may be used repeatedly in the same patient and potentially increase sensitivity to previously inefficient treatment modalities.

Nyckelord

Adult

Aged

Antibodies

Monoclonal

therapeutic use

Antigens

CD20

immunology

Antirheumatic Agents

therapeutic use

Arthralgia

drug therapy

immunology

B-Lymphocytes

immunology

Blood Sedimentation

drug effects

C-Reactive Protein

analysis

Drug Resistance

Female

Hemoglobins

analysis

Humans

Immunoglobulins

blood

Immunotherapy

methods

Leukocyte Count

Longitudinal Studies

Male

Methotrexate

pharmacology

Middle Aged

Platelet Count

Rheumatic Fever

blood

immunology

therapy

Rheumatoid Factor

blood

Tumor Necrosis Factor-alpha

antagonists & inhibitors

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)