Rituximab: a promising therapy in systemic lupus erythematosus.
Several trials of new immunologic agents in systemic lupus erythematosus (SLE) have recently been undertaken. Rituximab, a chimeric antibody directed against CD20 on B lymphocytes, has emerged as a promising therapy. Based upon preliminary data, clinical efficacy of rituximab has been documented in both pediatric and adult-onset SLE patients. The specific manifestations reported to be beneficially affected include lupus nephritis, arthralgia/arthritis, serositis, cutaneous vasculitis, mucositis, rashes, fatigue and neurologic symptoms. Although rituximab's mechanisms of action are incompletely understood, the effects of rituximab are likely mediated by antibody-dependent cell-mediated cytotoxicity and the induction of apoptosis. The resultant repopulation of B cells, alteration of abnormal B cell homeostasis and down-regulation of co-stimulatory molecules on both B and T cells all likely contribute to clinical efficacy. Good tolerability of rituximab is reported with rare serious side effects. The positive response to rituximab verifies a central role for B cells in SLE. This article highlights the clinical experience of rituximab therapy in both pediatric and adult-onset SLE. These data suggest a promising role for rituximab in the treatment of SLE. Further controlled trials and long-term outcome studies are imperative to further define its clinical application and to improve the care of patients.
Thatayatikom
Akaluck
A
Division of Immunology and Rheumatology, Department of Pediatrics, Saint Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Saint Louis, Missouri 63110, USA. thatayatikom_b@kids.wustl.edu
White
Andrew J
AJ
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000920:Antibody-Dependent Cell Cytotoxicity / Q000187:drug effects* / Q000276:immunology; D018951:Antigens, CD20 / Q000276:immunology*; D017209:Apoptosis / Q000187:drug effects* / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology* / Q000473:pathology; D002986:Clinical Trials as Topic; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D000069283:Rituximab; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab