Video: Superheroes, Secret Identities & You| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Lupus Nephritis
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • Technology
      • Information Technology
      • Apps
    • QA/QI
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
      • Education & Training
    • Certification
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Is B a Key to Autoimmune Therapy?: B Cell-Targeted Therapies in Autoimmune Disease

Jennifer Anolik, MD, PhD  |  Issue: January 2010  |  January 1, 2010

TABLE 2: Approaches to Target B Cells

B cell depletion

  • Rituximab (anti-CD20)
  • Ocrelizumab (humanized anti-CD20) (Phase III in RA and SLE)
  • Anti-CD20 (small modular immunopharmaceutical [SIMP]) (Phase III in RA)
  • Ofatumumab (anti-CD20 from humanized mice) (Phase III in RA)

Inhibitory signaling

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE
  • Epratuzumab (anti-CD22) (Phase II in SLE)

Cytokine blockade

  • Belimumab (anti-BAFF) (advanced development in RA, SLE)
  • BR3-Fc (Phase I RA)
  • Anti-BR3 (Phase I RA)
  • Atacicept (TACI-Ig) (Phase I, II complete in RA and SLE)

Clinical Utilization and Safety

Given that B-cell depletion is irreversible until reconstitution occurs (and persists for long periods during which the patient may not make antibodies to infections or immunization), clinicians may be less comfortable using this therapeutic approach in RA instead of a TNF blockade, which can be stopped. However, a recent meta-analysis supports prior literature regarding the safety of B-cell depletion in that treatment of RA with rituximab was not associated with an increased incidence of serious infections, even after repeated courses, or with TNF blockade after B-cell depletion.9-11 The caveat here is that the database is relatively small for RA and even smaller for SLE. Moreover, there have been reports of fulminant hepatitis B reactivation and rare cases of PML. Thus, patients should be screened for hepatitis B prior to the use of rituximab, and viral prophylaxis should be considered in high-risk patients.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Unfortunately, there are no screening methods to identify patients at risk for development of PML. A third case of PML was recently reported in an RA patient receiving rituximab, notably without prior anti-TNF treatment or risk factors for PML development, such as malignancy or heavy immunosuppression. Although the frequency of PML in RA patients receiving rituximab is rare (3 in 100,000 patients), a recent press release from Genentech notes that the information to date suggests that patients with RA who receive rituximab have an increased risk of PML. Current U.S. Food and Drug Administration recommendations are that rituximab only be used in later-stage RA patients who have inadequately responded to anti-TNF therapy, which has been our practice to date. Given that primary and secondary immune responses may be compromised even a year after therapy, it is also recommended that immunizations be given one month prior to starting rituximab, and the yearly influenza vaccine given as late as possible after the last dose.12 This would include vaccination for the novel H1N1 virus, but avoidance of live vaccines, similar to the practice for other immunocompromised populations. I also routinely monitor serum immunoglobulin levels (yearly) given the occurrence, albeit rare, of hypogammaglobulinemia and the fact that replacement intravenous immunoglobulin can be considered in the setting of severe hypogammaglobulinemia (serum IgG<200-300 mg/dl) (see Table 3, above).

Page: 1 2 3 4 5 6 7 8 | Single Page
Share: 

Filed under:ConditionsRheumatoid ArthritisSystemic Lupus Erythematosus Tagged with:Autoimmuneautoimmune inflammatory diseasesB cellsinflammationRheumatoid arthritisSLESystemic lupus erythematosus

Related Articles

    TNF Blockade for SLE

    September 1, 2010

    Reckless approach versus missed opportunity?

    T Cells in Systemic Lupus Erythematosus

    August 1, 2011

    Progress toward targeted therapy

    Lupus B Cell Research Points Toward Targeted Therapies

    January 19, 2018

    SAN DIEGO—B cell signaling goes awry in many patients with systemic lupus erythematosus (SLE), triggering pathogenic autoimmune responses and clinical disease. At the Rheumatology Research Foundation’s 2017 Evelyn V. Hess Memorial Lecture, held on Nov. 5 at the ACR/ARHP Annual Meeting, researcher Ignacio Sanz, MD, discussed B cells’ role in this complex disease. Because lupus…

    Cellular Therapy of Autoimmune Disease

    November 1, 2008

    Is a novel treatment breakthrough on the horizon?

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences