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Treating human autoimmune disease by depleting B cells
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  1. R J Looney
  1. University of Rochester, Rochester, New York, USA
  1. Correspondence to:
    Professor R J Looney, University of Rochester, 601 Elmwood Avenue, Rm G-6454, Rochester, NY 14642, USA;
    John_Looney{at}URMC.Rochester.edu

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Rituximab treatment is safe and justifies continued study

The development of rituximab has raised the hope of a new therapeutic approach for autoimmune diseases. In the United Sates rituximab is approved for indolent CD20+ B cell lymphomas, and it is also being evaluated in many different types of lymphomas as well as other B cell malignancies such as Waldenström's macroglobulinaemia and chronic lymphocytic leukaemia. World wide more than 300 000 patients with B cell malignancies have been treated with rituximab.1 Because rituximab is generally well tolerated and because it selectively and profoundly depletes B cells, its role in immune mediated diseases, especially autoimmunity, is now also being explored. Two articles in this issue of the Annals of the Rheumatic Diseases report the clinical use of rituximab in patients with autoimmune diseases.2,3 The first article consists of three case reports using rituximab in three different autoimmune diseases, and the second reports a series of 22 patients with rheumatoid arthritis (RA) treated with rituximab with various combinations of glucocorticoids and cyclophosphamide. Both articles found rituximab was well tolerated, and both concluded that there might have been some therapeutic benefit.

These articles are not the first reports on the use of rituximab in autoimmunity. Indeed, the same group reporting treatment of 22 patients with RA in this issue has previously reported on five patients with RA who had prolonged remission of RA with a three week course of treatment combining high dose, daily glucocorticoids, three weekly doses of rituximab, and two doses of cyclophosphamide.4 Other groups have reported the use of rituximab in idiopathic thrombocytic purpura, autoimmune haemolytic anaemia, cold agglutinin disease, and neuropathy associated with monoclonal IgM.5–10 None of these reports was adequately controlled. Thus, additional randomised clinical trials are needed for definitive evaluation of the …

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