Rituximab (Mabthera), a new approach for the treatment of rheumatoid arthritis. A systematic review

Abstract

Rituximab is a chimeric monoclonal antibody capable of depleting Bcells expressing CD20. Clinical trials carried out in patients diagnosedwith active, established RA confirm that a single cycle of rituximabgiven as two infusions a week apart, together with once weekly oralmethotrexate, produces enduring clinical responses comparable tothat observed with TNF blockade and may slow the rate of structuraldamage to joints. Rituximab, which has recently been approved for usein active rheumatoid arthritis refractory to TNF inhibitors, exhibits anacceptable safety record in rheumatoid arthritis trials, but its infusioncan be followed by reactions of variable frequency and severity which,in most instances, can be prevented by intravenous administration ofcorticosteroids and anti-histamines prior to the infusion. The long-termsafety record of rituximab as observed from the follow-up of patientstreated for non-Hodgkin’s lymphoma is favorable and reassuring.Current uncertainties regarding rituximab usage in rheumatoidarthritis are: (a) management of rituximab treatment failures, and (b)lack of reliable biomarkers to rationally indicate the best choice of thebiologic agent.

Keywords

• Arthritis
• rheumatoid/drug therapy
• Antibodies
• monoclonal/therapeutic use
• Antigens CD20