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Efficacy of Anti‐CD20 Treatment in Patients with Rheumatoid Arthritis Resistant to a Combination of Methotrexate/Anti‐TNF Therapy
Author(s) -
Bokarewa M.,
Lindholm C.,
Zendjanchi K.,
Nadali M.,
Tarkowski A.
Publication year - 2007
Publication title -
scandinavian journal of immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.934
H-Index - 88
eISSN - 1365-3083
pISSN - 0300-9475
DOI - 10.1111/j.1365-3083.2007.01995.x
Subject(s) - medicine , rituximab , rheumatoid arthritis , cd20 , methotrexate , antibody , gastroenterology , tumor necrosis factor alpha , combination therapy , rheumatology , immunology
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‐α 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‐α treatment. Of the 11 non‐responders, five were retreated with anti‐CD20 within 2 months, four of them with success, four patients received TNF‐α inhibitors, the remaining two patients received an additional DMARD. Most of the RA patients resistant to TNF‐α 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.