Treatment of Spondyloarthropathy
Rituximab, which is a chimeric anti-CD20 monoclonal antibody, has been proven effective in RA. Interestingly, although immunohistochemical stains of sacroiliac joint biopsies from SpA patients showed that T cells and macrophages were most frequent cells, the number of CD20+ B cells in the persistent inflamed joint from AS patients has been reported to be significantly higher than joints from controls or joints from AS patients without active inflammation.
Whether rituximab may be effective in SpA is presently unclear. In an open-label trial of rituximab in AS, rituximab was not ineffective for10 patients who were refractory to TNF inhibitors; at 24 weeks, 30% of patients achieved an Assessment of SpondyloArthritis International Society (ASAS) 20 response, a level typical of placebo in controlled trials. In 10 patients naïve to TNF inhibitors, there was modest efficacy, with 50% achieving an ASAS 20 response and 30% achieving partial remission. Among nine patients achieving ASAS 20 response (six TNF-α blocker naïve, three TNF-α blocker failure), five patients flared and received a second course of rituximab. Interestingly, patients had more improvement compared with the first course. In a retrospective analysis of the French registry data, among 26 SpA patients, rituximab showed only modest efficacy, and mostly among those patients naïve to TNF inhibitors.
In an open-label study of rituximab in psoriatic arthritis (PsA) patients, the primary end point – at least 30% improvement by PsA response criteria – was achieved by five of the nine patients. In another open-label study, the efficacy of rituximab for 21 patients with PsA modest improvement in arthritis and psoriasis was observed, especially in TNF inhibitor-naïve patients. At week 24, American College of Rheumatology (ACR) 20 responders were 30% of patients and Psoriasis Area and Severity Index (PASI) 75 responders were 15% of patients. Larger controlled studies are required to confirm the potential effect of rituximab in PsA.
B Cell (Rituximab)
Rituximab, which is a chimeric anti-CD20 monoclonal antibody, has been proven effective in RA. Interestingly, although immunohistochemical stains of sacroiliac joint biopsies from SpA patients showed that T cells and macrophages were most frequent cells, the number of CD20+ B cells in the persistent inflamed joint from AS patients has been reported to be significantly higher than joints from controls or joints from AS patients without active inflammation.
Whether rituximab may be effective in SpA is presently unclear. In an open-label trial of rituximab in AS, rituximab was not ineffective for10 patients who were refractory to TNF inhibitors; at 24 weeks, 30% of patients achieved an Assessment of SpondyloArthritis International Society (ASAS) 20 response, a level typical of placebo in controlled trials. In 10 patients naïve to TNF inhibitors, there was modest efficacy, with 50% achieving an ASAS 20 response and 30% achieving partial remission. Among nine patients achieving ASAS 20 response (six TNF-α blocker naïve, three TNF-α blocker failure), five patients flared and received a second course of rituximab. Interestingly, patients had more improvement compared with the first course. In a retrospective analysis of the French registry data, among 26 SpA patients, rituximab showed only modest efficacy, and mostly among those patients naïve to TNF inhibitors.
In an open-label study of rituximab in psoriatic arthritis (PsA) patients, the primary end point – at least 30% improvement by PsA response criteria – was achieved by five of the nine patients. In another open-label study, the efficacy of rituximab for 21 patients with PsA modest improvement in arthritis and psoriasis was observed, especially in TNF inhibitor-naïve patients. At week 24, American College of Rheumatology (ACR) 20 responders were 30% of patients and Psoriasis Area and Severity Index (PASI) 75 responders were 15% of patients. Larger controlled studies are required to confirm the potential effect of rituximab in PsA.
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