Update: B-Cells in Rheumatic Disease

Volume 7 | July 1, 2007 - September 30, 2007

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Highest Rated Articles

Anolik JH, Barnard J, Owen T, et al. Delayed memory B cell recovery in peripheral blood and lymphoid tissue in systemic lupus erythematosus after B cell depletion therapy. Arthritis Rheum 2007;56(9):3044-56.

One of the leading lupus B-cell immunobiology group describes rituximab-induced altered patterns in blood and tonsillar B-cell subset distribution, which they assert may correlate with clinical response status. These studies were performed after long-term follow-up of patients from a previously reported small phase I/II trial in patients with SLE who received three different regimens of rituximab infusions. After disregarding several patients from further analysis due to atypical baseline B-cell subset profiles or for inadequate rituximab treatment, the authors contend that they found evidence that persistent delays in recovery of pre-treatment levels of B-cell memory populations (ie, CD27+ and others) in blood and tonsillar biopsies correlates with (or is a biomarker for) prolonged clinical response. These hopeful analyses of a very limited number of patients (with likely bias in patient selection) are interpreted as evidence that anti-CD20 therapy may at times reset the balance within the B-cell compartment to an earlier pre-disease state. This hypothesis and the state-of-the-art analytic approach will no doubt be tested in larger randomized trials. 

Dass S, Vital EM, Emery P. Development of psoriasis after B cell depletion with rituximab. Arthritis Rheum 2007;56(8):2715-8.

This retrospective anecdotal case series describes three very different rheumatic patients who received standard doses of rituximab along with IV cyclophosphamide that newly developed biopsy-proven psoraiform lesions at the time of maximal B-cell depletion. This limited report raises the question of whether there are functional contributions of B cells, or their antibody products, that aid homeostasis to prevent the initiation phase of cutaneous psoriasis in some predisposed individuals. While neither B cells nor local immunoglobulin deposition are common components of these cutaneous lesions, synovial B-cell infiltrates are often seen in psoriatic arthritis. This report may therefore herald that current trials in psoriatic arthritis will show a dissociation of clinical responses to rituximab for skin and joint disease activity.

Ng KP, Cambridge G, Leandro MJ, Edwards JC, Ehrenstein M, Isenberg DA. B cell depletion therapy in systemic lupus erythematosus: long-term follow-up and predictors of response. Ann Rheum Dis 2007;66(9):1259-62.

Long-term follow-up (3-78 months) is described for the largest reported open trial of refractory SLE patients, who received treatments with a total dose of 1 gm rituximab. Most also received “Euro” doses of IV cyclophosphamide (dose?), along with different regimens of substantial corticosteroid regimens. While all of the 30/32 evaluable patients had some level of beneficial clinical responses, five patients flared in less than 6 months, nine flared in 6 to 12 months, and four flared in 12 to 28 months; the remaining 12 patients had sustained clinical benefits for 9 to 73 months after a single course of therapy. A baseline positive test for Extractable Nuclear Antigens (ie, Ro, La, RNP or Sm) and low C3 significantly correlate with earlier disease flare. Four serious adverse effects were seen in these generally very challenging patients, which suggested an attractive safety profile in light of their refractory clinical histories. While clinical response rates were impressive, these co-treatment regimens differ from reported phase I/II American trials, as well as with randomized controlled trials now in progress.

Other Rated Articles

Archives of Dermatology

Three Stars Cianchini G, Corona R, Frezzolini A, Ruffelli M, Didona B, Puddu P. Treatment of severe pemphigus with rituximab: report of 12 cases and a review of the literature. Arch Dermatol 2007;143(8):1033-8.

Arthritis and Rheumatology

Four Stars Cooper MA, Willingham DL, Brown DE, French AR, Shih FF, White AJ. Rituximab for the treatment of juvenile dermatomyositis: a report of four pediatric patients. Arthritis Rheum 2007;56(9):3107-11.

Autoimmunity Reviews

Three Stars Bugatti S, Codullo V, Caporali R, Montecucco C. B cells in rheumatoid arthritis. Autoimmun Rev 2007;6(7):482-7.
Three Stars Daridon C, Guerrier T, Devauchelle V, Saraux A, Pers JO, Youinou P. Polarization of B effector cells in Sjogren's syndrome. Autoimmun Rev 2007;6(7):427-31. [Epub 2007 Feb 8]

Clinical Journal of American Society of Nephrology

Three Stars Cravedi P, Ruggenenti P, Sghirlanzoni MC, Remuzzi G. Titrating rituximab to circulating B cells to optimize lymphocytolytic therapy in idiopathic membranous nephropathy. Clin J Am Soc Nephrol 2007;2(5):932-7. [Epub 2007 Aug 16]

Expert Opinion on Biological Therapy

Four Stars Dorner T, Lipsky PE. B-cell targeting: a novel approach to immune intervention today and tomorrow. Expert Opin Biol Ther 2007;7(9):1287-99.
Four Stars Nielsen CH, El Fassi D, Hasselbalch HC, Bendtzen K, Hegedus L. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves’ ophthalmopathy the latest addition to an expanding family. Expert Opin Biol Ther 2007;7(7):1061-78.

Journal of Immunology

Four Stars Ahuja A, Shupe J, Dunn R, Kashgarian M, Kehry MR, Shlomchik MJ. Depletion of B cells in murine lupus: efficacy and resistance. J Immunol 2007;179(5):3351-61.
Three Stars Tangye SG, Good KL. Human IgM+CD27+ B cells: memory B cells or “memory” B cells? J Immunol 2007;179(1):13-9.


Three Stars Sagaert X, Sprangers B, De Wolf-Peeters C. The dynamics of the B follicle: understanding the normal counterpart of B-cell-derived malignancies. Leukemia 2007;21(7):1378-86. [Epub 2007 May 10].

Molecular Immunology

Three Stars Glennie MJ, French RR, Cragg MS, Taylor RP. Mechanisms of killing by anti-CD20 monoclonal antibodies. Mol Immunol 2007;44(16):3823-37.

New England Journal of Medicine

Four Stars Joly P, Mouquet H, Roujeau JC, et al. A single cycle of rituximab for the treatment of severe pemphigus. N Engl J Med 2007;357(6):545-52.
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Copyright © 2000-2018 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 1950 Richmond Road, TR204, Lyndhurst, OH 44124