Goldblatt F, Isenberg D A
Centre for Rheumatology, Department of Medicine, University College London Hospital, 250 Euston Road, London, UK.
Handb Exp Pharmacol. 2008(181):163-81. doi: 10.1007/978-3-540-73259-4_8.
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are both chronic autoimmune rheumatic diseases. In the last few years, evolution in the understanding of RA and SLE pathogenesis and underlying molecular mechanisms has resulted in development and availability of novel therapies. In particular, the recent acknowledgement of a more significant role for B cells in the pathogenesis of RA, in contrast to the view that it was predominantly a T cell disorder, provided rationale for trials of B cell depletion therapy with the chimeric anti-CD20 monoclonal antibody rituximab. The efficacy and favourable safety profile of rituximab have resulted in the recent approval by the European Medicines Agency for its usage in patients with RA unresponsive to conventional therapies. The salient features from the pivotal open and randomised controlled trials are reviewed in this chapter. Given the recognition of B cell dysfunction as central to SLE pathogenesis, the use of anti-CD20 antibody therapy for this patient group has also been established. Results of the open trials have been encouraging, particularly in patients not responding to usual therapies, and a randomised controlled trial is underway.
类风湿关节炎（RA）和系统性红斑狼疮（SLE）均为慢性自身免疫性风湿性疾病。在过去几年中，对RA和SLE发病机制及潜在分子机制认识的进展，促使了新型疗法的研发与应用。特别是，与以往认为RA主要是T细胞疾病的观点不同，最近认识到B细胞在RA发病机制中发挥更重要作用，这为使用嵌合抗CD20单克隆抗体利妥昔单抗进行B细胞清除疗法的试验提供了理论依据。利妥昔单抗的疗效和良好的安全性已使其近期获得欧洲药品管理局批准，用于对传统疗法无反应的RA患者。本章将对关键的开放性和随机对照试验的显著特征进行综述。鉴于认识到B细胞功能障碍是SLE发病机制的核心，抗CD20抗体疗法在该患者群体中的应用也已确立。开放性试验的结果令人鼓舞，尤其是对常规疗法无反应的患者，一项随机对照试验正在进行中。
