Efficacy of selective B cell blockade in the treatment of rheumatoid arthritis: Evidence for a pathogenetic role of B cells

• Salvatore De Vita

• Francesco Zaja

• Stefania Sacco

• Alessandro De Candia

• Renato Fanin

• Gianfranco Ferraccioli

抄録

The pathogenetic role of B cells in rheumatoid arthritis (RA) is under debate, but it is currently believed to be marginal. The availability of selective anti–B cell treatment provides a unique opportunity to clarify this issue. This study was undertaken to investigate the effects of B cell blockade in the treatment of refractory RA, and to evaluate the implications with regard to the role of B cells in the disease. Five female patients with active, evolving erosive RA were treated with rituximab, an anti‐CD20 chimeric monoclonal antibody. All 5 patients had been nonresponders to combination therapy with methotrexate plus cyclosporin A. Two of the 5 had also failed to respond to anti–tumor necrosis factor α therapy. All of these treatments were discontinued 1 month before institution of anti‐CD20 therapy. Marked clinical improvement was observed in 2 patients (American College of Rheumatology 70% response [ACR70] and ACR50, respectively), starting at the end of the second month after institution of anti‐CD20 therapy (month 2) and lasting until month 10 in 1 patient (articular relapse) and month 12 in the other (last followup). ACR20 response was observed in 2 additional patients, lasting until month 5 and month 7, respectively (articular relapse in both). Decrease or normalization of serum C‐reactive protein and rheumatoid factor levels were observed in these patients. In contrast, patient 3 had no response to the treatment. RA synovitis and evolving erosive damage were decreased in patients exhibiting a major response, as demonstrated by imaging studies. Our finding of the clinical efficacy of selective B cell blockade indicates that B cells play a critical role in rheumatoid synovitis, at least in a subset of patients. Qualitative or quantitative differences in B cell commitment in RA pathobiology might have a function in the different responses observed.

収録刊行物

• Arthritis & Rheumatism

  Arthritis & Rheumatism 46 (8), 2029-2033, 2002-08

  Wiley

キーワード

• Pharmacology (medical)
• Immunology
• Rheumatology
• Immunology and Allergy

詳細情報

• CRID: 1360011145365535360
• NII論文ID: 30013439784
• DOI: 10.1002/art.10467
• ISSN: 15290131
• ISSN: 00043591
• ISSN: http://id.crossref.org/issn/00043591
• Web Site: https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fart.10467
• Web Site: https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.10467
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