REVIEW - A review of the current use of rituximab in autoimmune diseases

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Int Immunopharmacol. 2009 Jan;9(1):10-25. Epub 2008 Nov 8.

A review of the current use of rituximab in autoimmune diseases.

Gürcan HM, Keskin DB, Stern JN, Nitzberg MA, Shekhani H, Ahmed AR.

Center for Blistering Diseases, New England Baptist Hospital, Boston,

MA 02120, USA.

Rituximab is a human/murine chimeric monoclonal antibody primarily

used for treating non-Hodgkin's B-cell lymphoma. Recently it has also

been used in the treatment of several autoimmune diseases. A

literature review was conducted to determine the efficacy of rituximab

in the treatment of some of these autoimmune diseases. Multiple

mechanisms proposed for the rituximab mediated B cell depletion are

also discussed. The efficacy of rituximab is well-established and it

is FDA approved for treatment of Rheumatoid arthritis. In this review,

data on the use of rituximab is presented from 92 studies involving

1197 patients with the following diseases: systemic lupus

erythematosus, idiopathic thrombocytopenic purpura, anti-neutrophil

cytoplasmic antibody associated vasculitis, Grave's disease,

autoimmune hemolytic anemia, pemphigus vulgaris, hemophilia A, cold

agglutinin disease, Sjogren's syndrome, graft vs. host disease,

thrombotic thrombocytopenic purpura, cryoglobulinemia, IgM mediated

neuropathy, multiple sclerosis, neuromyelitis optica, idiopathic

membranous nephropathy, dermatomyositis, and opsoclonus myoclonus. The

efficacy varies among different autoimmune diseases. The cumulative

data would suggest that in the vast majority of studies in this

review, RTX has a beneficial role in their treatment. While rituximab

is very effective in the depletion of B cells, current research

suggests it may also influence other cells of the immune system by

re-establishing immune homeostasis and tolerance. The safety profile

of RTX reveals that most reactions are infusion related. In patients

with autoimmune diseases the incidence of serious and severe side

effects is low. Systemic infection still remains a major concern and

may result in death.

PMID: 19000786

http://www.ncbi.nlm.nih.gov/pubmed/19000786

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