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Clinical outcome in 22 patients with rheumatoid arthritis treated with B lymphocyte depletion
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  1. M J Leandro,
  2. J C W Edwards,
  3. G Cambridge
  1. Centre for Rheumatology, University College London, UK
  1. Correspondence to:
    Professor J C W Edwards, Centre for Rheumatology, Arthur Stanley House, 40–50 Tottenham Street, London W1T 4NJ, UK;
    jo.edwards{at}ucl.ac.uk

Abstract

Objectives: To obtain evidence for dose response and to extend evidence of safety and efficacy for B lymphocyte depletion in rheumatoid arthritis.

Methods: Twenty two patients with rheumatoid arthritis received a total of 29 treatments with five different combinations of rituximab (RTX), cyclophosphamide (CP), and/or high dose prednisolone (PR) on an open basis as follows; cohort I: RTX 1400 mg/m2, CP 750×2+PR; cohort II: RTX 300–700 mg/m2, −CP±PR); cohort III: RTX 600–700 mg/m2, CP 750×2+PR; cohort IV: RTX 1200 mg/m2, CP 750×2−PR; cohort V: RTX 500 mg/m2, CP 750×2+PR. American College of Rheumatology (ACR) criteria of improvement at six months were chosen as the primary outcome measure. Disease activity scores and total duration of improvement and of B cytopenia were also recorded.

Results: No major adverse events attributable to treatment were seen. ACR grades of improvement at six months were as follows: cohort I: ACR70×3, ACR50×2; cohort II: ACR20×1, ACR0×3; cohort III: ACR70×6, ACR50×2, ACR20×2; cohort IV: ACR70×2, ACR50×2, ACR20×1, ACR0×1; cohort V: ACR0×4.

Conclusions: B lymphocyte depletion in rheumatoid arthritis has so far proved to be safe and associated with major improvement with protocols including RTX 600 mg/m2 or more and CP, but not with more limited protocols. These observations provide an initial basis for the design of formal trials of B cell depletion and other B cell directed treatments, including a phase II controlled trial now in progress.

  • rituximab
  • anti-CD20
  • rheumatoid arthritis
  • autoimmunity
  • ACR, American College of Rheumatology
  • DMARDs, disease modifying antirheumatic drugs
  • RA, rheumatoid arthritis
  • RF, rheumatoid factor
  • TNFα, tumour necrosis factor α
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