Critical analysis of rituximab-induced serological changes in connective tissue diseases

Autoimmun Rev. 2009 May;8(6):515-9. doi: 10.1016/j.autrev.2009.01.007. Epub 2009 Jan 30.

Abstract

A survey of PUBMED and EMBASE supplied 21 articles dealing with the effect of rituximab (RTX) on immunoglobulin (Ig) and autoantibodies (Abs) in nonorgan-systemic autoimmune diseases, and another 12 articles were found by hand search. No statistics could be performed due to the lack of numerical data in the articles. RTX tended to diminish total Ig but still within the normal ranges, more for IgM than IgG and IgA. Rheumatoid factor level decreased by 30 to 60% 3-6 months after RTX, whereas anti-cyclic citrullinated peptide Ab titers declined modestly. In contrast, anti-DNA and anti-C1q Ab levels showed a marked decrease, whereas the other anti-extractable nuclear antigens Ab (anti-SSA, SSB, SM, RNP...) were stable. There are claims for an increase in the BAFF level by approximately 2.5 to 3-fold at 3-4 months, and a return to pre-treatment value at 8-12 months. RTX-induced changes in the serum bring about new insights into mechanisms of action. Therefore, more attention should be paid to such parameters in clinical trials.

MeSH terms

  • Animals
  • Antibodies, Monoclonal / immunology
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Antibody Formation / drug effects*
  • Antibody Formation / immunology
  • Antigens, Nuclear / immunology
  • Autoantibodies / blood
  • B-Cell Activating Factor / immunology
  • B-Lymphocytes / drug effects*
  • B-Lymphocytes / metabolism
  • B-Lymphocytes / pathology
  • Complement C1q / immunology
  • Connective Tissue Diseases / blood*
  • Connective Tissue Diseases / drug therapy*
  • Connective Tissue Diseases / immunology
  • Databases, Bibliographic
  • Humans
  • Lymphocyte Depletion
  • Peptides, Cyclic / immunology
  • Rheumatoid Factor / immunology
  • Rituximab
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, Nuclear
  • Autoantibodies
  • B-Cell Activating Factor
  • Peptides, Cyclic
  • TNFSF13B protein, human
  • cyclic citrullinated peptide
  • Rituximab
  • Complement C1q
  • Rheumatoid Factor