Anti-CD20 (rituximab) treatment improves atopic eczema

被引:197
作者
Simon, Dagmar [2 ]
Hosli, Susanne [1 ]
Kostylina, Ganna [1 ]
Yawalkar, Nikhil [2 ]
Simon, Hans-Uwe [1 ]
机构
[1] Univ Bern, Dept Pharmacol, CH-3010 Bern, Switzerland
[2] Univ Bern, Dept Dermatol, CH-3010 Bern, Switzerland
关键词
atopic dermatitis; B cells; biologics; cytokines; inflamation; rituximab; T cells;
D O I
10.1016/j.jaci.2007.11.016
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Atopic eczema (AE) is a chronic inflammatory skin disorder characterized by eczematous skin lesions, pruritus, and typical histopathologic features. Objective: We asked whether depletion of B cells by monoclonal anti-CD20 antibody therapy (rituximab) would improve severe AE. Methods: Six patients (4 women and 2 men) with severe AE received 2 intravenous applications of rituximab, each 1000 mg, 2 weeks apart. To evaluate the efficacy of rituximab, we monitored clinical parameters (eczema area and severity index, pruritus), total and allergen-specific IgE levels, skin histology, and inflammatory cells and cytokine expression in the skin and peripheral blood before and after therapy (ClinicalTrials.gov Identifier: NCT00267826). Results: All patients showed an improvement of their skin symptoms within 4 to 8 weeks. The eczema area and severity index significantly decreased (before therapy, 29.4 +/- 4.3; week 8, 8.4 +/- 3.6; P <.001). Histologic alterations such as spongiosis, acanthosis, and dermal infiltrate, including T and B cell numbers, also dramatically improved. However, whereas blood B cells were below detectable levels as a consequence of rituximab administration, skin B cells were reduced by approximately 50% only. Expression of IL-5 and IL-13 was reduced after therapy. Moreover, whereas allergen-specific IgE levels were not altered, we observed a slight reduction in total IgE concentrations in blood. Conclusions: B cells play a major role in AE pathogenesis. Treatment with an anti-CD20 antibody leads to an impressive improvement of AE in patients with severe disease.
引用
收藏
页码:122 / 128
页数:7
相关论文
共 49 条
  • [1] Treatment of pemphigus vulgaris with rituximab and intravenous immune globulin
    Ahmed, A. Razzaque
    Spigelman, Zachary
    Cavacini, Lisa A.
    Posner, Marshall R.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (17) : 1772 - 1779
  • [2] T cells and T cell-derived cytokines as pathogenic factors in the nonallergic form of atopic dermatitis
    Akdis, CA
    Akdis, M
    Simon, D
    Dibbert, B
    Weber, M
    Gratzl, S
    Kreyden, O
    Disch, R
    Wüthrich, B
    Blaser, K
    Simon, HU
    [J]. JOURNAL OF INVESTIGATIVE DERMATOLOGY, 1999, 113 (04) : 628 - 634
  • [3] Anti-CD20 monoclonal antibody (rituximab) in the treatment of pemphigus
    Arin, MJ
    Engert, A
    Krieg, T
    Hunzelmann, N
    [J]. BRITISH JOURNAL OF DERMATOLOGY, 2005, 153 (03) : 620 - 625
  • [4] THE PRESENCE OF IGE MOLECULES ON EPIDERMAL LANGERHANS CELLS IN PATIENTS WITH ATOPIC-DERMATITIS
    BRUYNZEELKOOMEN, C
    VANWICHEN, DF
    TOONSTRA, J
    BERRENS, L
    BRUYNZEEL, PLB
    [J]. ARCHIVES OF DERMATOLOGICAL RESEARCH, 1986, 278 (03) : 199 - 205
  • [5] Serologic changes following B lymphocyte depletion therapy for rheumatoid arthritis
    Cambridge, G
    Leandro, MJ
    Edwards, JCW
    Ehrenstein, MR
    Salden, M
    Bodman-Smith, M
    Webster, ADB
    [J]. ARTHRITIS AND RHEUMATISM, 2003, 48 (08): : 2146 - 2154
  • [6] B cell maturation and selection at the marrow-periphery interface
    Cancro, MP
    Allman, DM
    Hayes, CE
    Lentz, VM
    Fields, RG
    Sah, AP
    Tomayko, M
    [J]. IMMUNOLOGIC RESEARCH, 1998, 17 (1-2) : 3 - 11
  • [7] Old meets new: The interaction between innate and adaptive immunity
    Clark, R
    Kupper, T
    [J]. JOURNAL OF INVESTIGATIVE DERMATOLOGY, 2005, 125 (04) : 629 - 637
  • [8] Treatment of resistant pemphigus vulgaris with an anti-CD20 monoclonal antibody (Rituximab)
    Cooper, HL
    Healy, E
    Theaker, JM
    Friedmann, PS
    [J]. CLINICAL AND EXPERIMENTAL DERMATOLOGY, 2003, 28 (04) : 366 - 368
  • [9] Efficacy of selective B cell blockade in the treatment of rheumatoid arthritis - Evidence for a pathogenetic role of B cells
    De Vita, S
    Zaja, F
    Sacco, S
    De Candia, A
    Fanin, R
    Ferraccioli, G
    [J]. ARTHRITIS AND RHEUMATISM, 2002, 46 (08): : 2029 - 2033
  • [10] Treatment of refractory pemphigus vulgaris with rituximab (anti-CD20 monoclonal antibody)
    Dupuy, A
    Viguier, M
    Bédane, C
    Cordoliani, F
    Blaise, S
    Aucouturier, F
    Bonnetblanc, JM
    Morel, P
    Dubertret, L
    Bachelez, H
    [J]. ARCHIVES OF DERMATOLOGY, 2004, 140 (01) : 91 - 96