Rituxan for arteritis – pro
Rituximab, a chimeric IgG1 antibody that binds to CD20 expressed on the surface of B cells, has been reported to improve clinical signs and symptoms of Takayasu arteritis. Although the pathogenesis of Takayasu arteritis is not believed to be mediated by the humoral immune system, B cells are believed to have an antibody-independent effect, which may modulate regulatory T-cell immune reactions against foreign and self-antigens. Galarza et al. reported good clinical response to rituximab, evidenced by improvement in clinical signs and symptoms, in one of two patients with TAK refractory to methotrexate and TNF- inhibitors. Hoyer et al reported three patients with refractory TAK despite prednisone, mycophenolic acid, cyclosporine and adalimumab, who responded to rituximab. Of note, anti-CD20 therapy normalized the number of peripheral plasma cell precursors, which subsequently increased during relapse in two patients that were successfully retreated with B-cell depletion. No prospective trial has proved this finding.
Unizony, Sebastian et al, New treatment strategies in large-vessel vasculitis
Current Opinion in Rheumatology: January 2013 – Volume 25 – Issue 1 – p 39
Hoyer BF, Mumtaz IM, Loddenkemper K, et al. Takayasu arteritis is characterized by disturbances of B cell homeostasis and responds to B cell depletion therapy with rituximab. Ann Rheum Dis 2012; 71:7579.