B lymphocyte depletion in rheumatoid arthritis: targeting of CD20.
BACKGROUND
During the 1990s evidence emerged to suggest that B lymphocyte depletion in rheumatoid arthritis (RA) might be of major benefit.


RESULTS
In 1997 the B lympholytic monoclonal anti-CD20 antibody rituximab became available. Significant clinical efficacy has been demonstrated in RA, initially in open studies at University College London and recently in a multicentre randomised controlled trial. Forty RA patients at University College London have now received in total 75 treatment cycles with rituximab (up to 4 individually) alone or in combination with corticosteroid, cyclophosphamide and/or methotrexate. Ongoing immunodynamic studies of these patients have shed light on a number of questions about both the therapeutic potential of B cell targeting, and the pathogenesis of RA.


CONCLUSIONS
The effects of B lymphocyte depletion lend increasing support to the idea that both the inflammatory effector mechanism and the underlying immunoregulatory disturbance in RA are driven by autoantibody rather than T cells.
Edwards
Jonathan C W
JC
Centre for Rheumatology, University College London, London, UK. jo.edwards@ucl.ac.uk
Leandro
Maria J
MJ
Cambridge
Geraldine
G
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D001402:B-Lymphocytes / Q000276:immunology*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D008212:Lymphocyte Depletion / Q000009:adverse effects; D008727:Methotrexate / Q000627:therapeutic use; D018448:Models, Immunological; D012217:Rheumatoid Factor / Q000097:blood; D000069283:Rituximab
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab; D003520:Cyclophosphamide; D012217:Rheumatoid Factor; D008727:Methotrexate