title: Improving B-cell depletion in systemic lupus erythematosus and rheumatoid arthritis.
abstract: Rituximab-based B-cell depletion (BCD) therapy is effective in refractory rheumatoid arthritis (RA) and although used to treat patients with refractory systemic lupus erythematosus (SLE) in routine clinical practice, rituximab failed to meet the primary endpoints in two large randomised controlled trials (RCTs) of non-renal (EXPLORER) and renal (LUNAR) SLE. Areas covered: We review how BCD could be improved to achieve better clinical responses in RA and SLE. Insights into the variability in clinical response to BCD in RA and SLE may help develop new therapeutic strategies. To this end, a literature search was performed using the following terms: rheumatoid arthritis, systemic erythematosus lupus, rituximab and B-cell depletion. Expert commentary: Poor trial design may have, at least partly, contributed to the apparent lack of response to BCD in the two RCTs of patients with SLE. Enhanced B-cell depletion and/or sequential therapy with belimumab may improve clinical response at least in some patients with SLE.
authors.affiliation: a Department of Internal Medicine , Hospital da Luz , Lisbon , Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Mota
authors.affiliation: b Centre for Rheumatology, Division of Medicine , University College London , London , UK.
authors.forename: Venkat
authors.initials: V
authors.lastname: Reddy
authors.affiliation: b Centre for Rheumatology, Division of Medicine , University College London , London , UK.
authors.forename: David
authors.initials: D
authors.lastname: Isenberg
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000628:therapy*; D001402:B-Lymphocytes / Q000276:immunology*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008180:Lupus Erythematosus, Systemic / Q000276:immunology / Q000628:therapy*; D008212:Lymphocyte Depletion; D012107:Research Design; D000069283:Rituximab / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069283:Rituximab; C511911:belimumab
keywords: B-cell biology; B-cell depletion; RA; SLE; lupus nephritis