title: Rituximab in diffuse cutaneous systemic sclerosis: should we be using it today?
abstract: There is new evidence that B-cell depletion could be an effective intervention in patients with SSc. Observational case-control study data from the European League Against Rheumatism Scleroderma Trials and Research group has suggested that rituximab therapy may reduce progression of skin thickening and lung fibrosis, especially in a subgroup with early dcSSc. These positive data remain preliminary and need to be viewed with caution, recognizing the spontaneous regression of skin thickening that may occur during early disease. In this review, we summarize the clinical evidence for the therapeutic use of rituximab in SSc as well as the basic science evidence suggesting that B cells and autoantibodies are the primary drivers of fibrosis in skin and lung tissue. We have also reviewed the parallels between SSc and the other CTDs where B-cell depletion therapy is efficacious.
authors.affiliation: Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, Department of Rheumatology, Waikato Hospital and Waikato Clinical School, University of Auckland, Hamilton, New Zealand Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, Department of Rheumatology, Waikato Hospital and Waikato Clinical School, University of Auckland, Hamilton, New Zealand f.mcqueen@auckland.ac.nz.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: McQueen
authors.affiliation: Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, Department of Rheumatology, Waikato Hospital and Waikato Clinical School, University of Auckland, Hamilton, New Zealand Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, Department of Rheumatology, Waikato Hospital and Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
authors.forename: Kamal
authors.initials: K
authors.lastname: Solanki
mesh_terms: D000818:Animals; D058846:Antibodies, Monoclonal, Murine-Derived / Q000494:pharmacology / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001323:Autoantibodies / Q000502:physiology; D001402:B-Lymphocytes / Q000187:drug effects / Q000473:pathology* / Q000502:physiology; D004195:Disease Models, Animal; D005355:Fibrosis / Q000517:prevention & control; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D051379:Mice; D000069283:Rituximab; D045743:Scleroderma, Diffuse / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D001323:Autoantibodies; D000069283:Rituximab
keywords: B-cell depletion; diffuse cutaneous systemic sclerosis; rituximab