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Improving B-cell depletion in systemic lupus erythematosus and rheumatoid arthritis.

Authors
  • Mota, Pedro1
  • Reddy, Venkat2
  • Isenberg, David2
  • 1 a Department of Internal Medicine , Hospital da Luz , Lisbon , Portugal.
  • 2 b Centre for Rheumatology, Division of Medicine , University College London , London , UK.
Type
Published Article
Journal
Expert Review of Clinical Immunology
Publisher
Informa UK (Taylor & Francis)
Publication Date
July 2017
Volume
13
Issue
7
Pages
667–676
Identifiers
DOI: 10.1080/1744666X.2017.1259068
PMID: 27841031
Source
Medline
Keywords
License
Unknown

Abstract

Rituximab-based B-cell depletion (BCD) therapy is effective in refractory rheumatoid arthritis (RA) and although used to treat patients with refractory systemic lupus erythematosus (SLE) in routine clinical practice, rituximab failed to meet the primary endpoints in two large randomised controlled trials (RCTs) of non-renal (EXPLORER) and renal (LUNAR) SLE. Areas covered: We review how BCD could be improved to achieve better clinical responses in RA and SLE. Insights into the variability in clinical response to BCD in RA and SLE may help develop new therapeutic strategies. To this end, a literature search was performed using the following terms: rheumatoid arthritis, systemic erythematosus lupus, rituximab and B-cell depletion. Expert commentary: Poor trial design may have, at least partly, contributed to the apparent lack of response to BCD in the two RCTs of patients with SLE. Enhanced B-cell depletion and/or sequential therapy with belimumab may improve clinical response at least in some patients with SLE.

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