Neuroimmunology Section, Department of Pathophysiology, University of Athens Medical School, Athens, Greece.
Ther Adv Neurol Disord. 2010 Mar;3(2):93-105. doi: 10.1177/1756285609356135.
Rituximab (Mabthera, Rituxan) is a chimeric human/murine monoclonal antibody against CD-20 surface antigen expressed on B-cells. Rituximab, by causing B-cell depletion, appears to be effective in several autoimmune disorders; it has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders. A controlled study in patients with relapsing remitting multiple sclerosis has shown that rituximab significantly reduces the number of new MRI lesions and improves clinical outcome; it also showed some promise in a subset of patients with primary progressive MS. The drug is also effective in a number of patients with Devic's disease, myasthenia gravis, autoimmune neuropathies, and inflammatory myopathies. The apparent effectiveness of rituximab has moved B-cells into the center stage of clinical and laboratory investigation of autoimmune neurological disorders. We review the evidence-based effectiveness of rituximab in neurological disorders based on controlled trials and anecdotal reports, including our own experience, and address the immunobiology of B-cells in autoimmune central nervous system (CNS) and peripheral nervous system (PNS) disorders. In addition, we provide practical guidelines on how best to use this drug in clinical practice and highlight its potential toxicity.
利妥昔单抗（美罗华，瑞复美）是一种针对表达在 B 细胞表面的 CD-20 抗原的嵌合人/鼠单克隆抗体。利妥昔单抗通过引起 B 细胞耗竭，似乎在几种自身免疫性疾病中有效；它已被批准用于类风湿关节炎，并且是治疗几种自身免疫性神经疾病的有前途的新药物。一项针对复发缓解型多发性硬化症患者的对照研究表明，利妥昔单抗可显著减少新的 MRI 病变数量并改善临床结局；它在原发性进行性多发性硬化症的一部分患者中也显示出一定的疗效。该药在一些 Devic 病、重症肌无力、自身免疫性神经病和炎性肌病患者中也有效。利妥昔单抗的明显疗效使 B 细胞成为自身免疫性神经疾病的临床和实验室研究的中心。我们根据对照试验和案例报告，包括我们自己的经验，回顾了利妥昔单抗在神经疾病中的循证疗效，并探讨了 B 细胞在自身免疫性中枢神经系统（CNS）和周围神经系统（PNS）疾病中的免疫生物学。此外，我们提供了关于如何在临床实践中最佳使用该药的实用指南，并强调了其潜在的毒性。
