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B cell or T cell-dominant recurrence after rituximab therapy in patients with SLE
  1. Shigeru Iwata,
  2. Kazuyoshi Saito,
  3. Mikiko Tokunaga,
  4. Yoshiya Tanaka
  1. The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  1. Correspondence to Yoshiya Tanaka, The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; tanaka{at}med.uoeh-u.ac.jp

http://dx.doi.org/10.1136/annrheumdis-2012-201317

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    Systemic lupus erythematosus (SLE) is an autoimmune disease induced by autoreactive T cell activation and B cell autoantibody overproduction. The efficacy of rituximab in refractory SLE has been documented, although some patients show partial response only.1,–,9 We report here two patients with SLE who showed T cell-dominant flare-up and two others who showed B cell-dependent flare-up, after long-term remission induced by rituximab administered at 375 mg/m2 twice/week.

    Rituximab rapidly depleted peripheral naive and memory B cells in patients with SLE. Patients with prolonged remission had persistent depletion of memory B cells for >2 years, whereas recovery of naive B cells occurred within 3–9 months. The expression levels of CD80 on B cells diminished rapidly and remained downregulated. Furthermore, CD69 and ICOS (inducible T-cell co-stimulator) expression levels on CD4+ T cells also decreased and remained at low levels.10

    B cell-dominant recurrence occurred in two patients, who were concurrently positive for anti-ds-DNA antibodies and extractable nuclear antigen, with lupus nephritis (class II) before treatment …

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    Footnotes

    • Competing interests YT has received consulting fees, speaking fees and/or honoraria from Mitsubishi-Tanabe Pharma, Chugai Pharma, Eisai Pharma, Pfizer, Abbott Immunology Pharma, Daiichi-Sankyo, Janssen Pharma, Astra-Zeneca, Takeda Industrial Pharma, Astellas Pharma, Asahi-kasei Pharma and GlaxoSmithKline and has received research grant support from Mitsubishi-Tanabe Pharma, Bristol-Myers Squibb, Takeda Industrial Pharma, MSD, Astellas Pharma, Eisai Pharma, Chugai Pharma, Pfizer and Daiichi-Sankyo. The other authors declare no conflict of interest.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.