oa SA Pharmaceutical Journal - Rituximab : use in rheumatoid arthritis : medifile : clinical review
RA has an intricate pathogenesis and several inflammatory mediators can be targeted with treatment. One such a mediator is the B lymphocyte.
B cells act as antigen-presenting cells, secrete proinflammatory cytokines, produce rheumatoid factor autoantibodies and activate T cells. RF autoantibodies play an important role in the pathogenesis of this disease, because they contribute to further release of inflammatory cytokines such as TNF-α. B cell treatment would therefore eliminate the cells responsible for the production of pathogenic autoantibodies and cytokines.
Rituximab is a chimeric monoclonal antibody against the CD20 surface marker on B cells and treatment with it leads to prolonged depletion of normal B cells from peripheral blood. The drug was first registered for non-Hodgkin's lymphoma, but has been found to be helpful in a number of autoimmune conditions, including rheumatoid arthritis.
Adverse events of rituximab in rheumatoid arthritis are similar to those experienced in patients with non-Hodgkin's lymphoma, and consist mainly of infusion reactions. Opportunistic infections like TB have not been reported in patients receiving treatment for RA, but testing for hepatitis B and C before starting with rituximab treatment should be considered.
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