title: Usefulness of monitoring of B cell depletion in rituximab-treated rheumatoid arthritis patients in order to predict clinical relapse: a prospective observational study.
abstract: Our objective was to evaluate the contribution of monitoring B cell subset depletion after rituximab in patients with rheumatoid arthritis (RA) in order to guide reintroduction to forestall relapse. This prospective, monocentre study included all RA patients receiving two 1-g rituximab infusions at a 15-day interval. The patients were followed clinically and biologically every 2 months until rituximab reintroduction. The physician was blinded to lymphocyte-typing results to diagnose relapse and, hence, retreatment. Among the 39 patients included between March 2010 and December 2011 and followed until April 2013, seven received two rituximab cycles, yielding a total of 46 cycles for analysis. After the two rituximab cycles, the total number of CD19(+) B cells decreased significantly (0·155 versus 0·0002 G/l, P < 0·0001), with complete depletions in all patients of CD19(+) CD38(++) CD24(++) (transitional) (P < 0·0001) and CD19(+) CD27(+) (memory) B lymphocytes. A significant majority of patients relapsed within the 4 months following repopulation of total B (P = 0·036), B transitional (P = 0·007) and B memory (P = 0·01) lymphocytes. CD19(+) B lymphocyte repopulation preceded clinical RA relapse and enabled its prediction 4 months in advance. Hence, monitoring of CD19(+) B lymphocytes could serve as a tool to predict those relapses.
authors.affiliation: Rouen University Hospital, Department of Rheumatology, France.
authors.forename: A-P
authors.initials: AP
authors.lastname: Trouvin
authors.forename: S
authors.initials: S
authors.lastname: Jacquot
authors.forename: S
authors.initials: S
authors.lastname: Grigioni
authors.forename: E
authors.initials: E
authors.lastname: Curis
authors.forename: I
authors.initials: I
authors.lastname: Dedreux
authors.forename: A
authors.initials: A
authors.lastname: Roucheux
authors.forename: H
authors.initials: H
authors.lastname: Boulard
authors.forename: O
authors.initials: O
authors.lastname: Vittecoq
authors.forename: X
authors.initials: X
authors.lastname: Le Loët
authors.forename: O
authors.initials: O
authors.lastname: Boyer
authors.forename: V
authors.initials: V
authors.lastname: Goëb
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D015703:Antigens, CD / Q000276:immunology; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D001402:B-Lymphocytes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008212:Lymphocyte Depletion / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015703:Antigens, CD; D018501:Antirheumatic Agents; D000069283:Rituximab
keywords: B lymphocyte depletion; rheumatoid arthritis; rituximab