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Update on the use of rituximab for intractable rheumatoid arthritis
Open Access Rheumatology: Research and Reviews, 08/11/09

John Looney RJ – Rituximab, a mouse x human chimeric anti-CD20 monoclonal antibody that selectively depleted B cells, was approved by the FDA for the treatment of moderate to severe rheumatoid arthritis (RA) with an inadequate response to anti-TNF therapies. This article reviews the additional data on long term clinical efficacy, and safety from the post-marketing surveillance.

• In long-term f/u from clinical trials, pts treated with multiple courses of rituximab continued to respond in terms of signs and symptoms
• Damage assessed radiographically was significantly inhibited
• Moreover, the rate of serious infectious events was not increased as the number of courses increased
• However, because of case reports of progressive multifocal leukoencephalopathy in pts treated with rituximab for non-malignant conditions, a black box warning has been added
• Studies on the immunologic correlates of response to rituximab treatment are providing clues into how rituximab works for autoimmune disease
• However, an explanation as to why some pts do not respond and who will respond is not available
• Future challenges for the further development of rituximab for intractable RA is also discussed

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