The effect of rituximab on humoral and cell mediated immunity and infection in the treatment of autoimmune diseases

被引:120
作者
Cooper, Nichola [1 ]
Arnold, Donald M. [2 ,3 ]
机构
[1] Imperial Hlth Care Trust, Dept Haematol, London, England
[2] McMaster Univ, Michael DeGroote Sch Med, Dept Med, Hamilton, ON, Canada
[3] Canadian Blood Serv, Hamilton, ON, Canada
关键词
rituximab; PML; ITP; infections; hepatitis B; SYSTEMIC-LUPUS-ERYTHEMATOSUS; ANTI-CD20; MONOCLONAL-ANTIBODY; B-LYMPHOCYTE DEPLETION; PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; CHRONIC HEPATITIS-B; IMPAIRED ISOTYPE EXPRESSION; NON-HODGKIN-LYMPHOMA; RHEUMATOID-ARTHRITIS; THROMBOCYTOPENIC PURPURA; IN-VIVO;
D O I
10.1111/j.1365-2141.2010.08076.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
P>Depletion of B lymphocytes using the anti-CD20 monoclonal antibody rituximab has wide-spread use in the treatment of patients with autoimmune disorders. As haematopoietic progenitor cells and only a fraction of differentiated plasma express CD20, the effect of rituximab on immune function appears to be minimal. However, hypogammagobulinaemia can occur with repeated doses and emerging data from large studies suggest a subtle increase in the risk of infection. Reactivation of latent JC virus, resulting in progressive multifocal leucoencephalopathy, and hepatitis B virus, resulting in hepatoxicity, have been documented in patients receiving rituximab; although confounding effects of concomitant immunosuppressive therapies and immune dysregulation due to the underlying disease make causal associations of infections problematic. This review discusses the efficacy of B cell depletion therapy in the treatment of autoimmune diseases, the effect of B cell depletion on infection and immunity including the role of the B cell in autoimmunity, and identifies areas of controversy.
引用
收藏
页码:3 / 13
页数:11
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