Rituximab-it was the best of times, it was the worst of times.

B cell depletion (BCD) has become established in the treatment of patients with rheumatoid arthritis (RA) vasculitis and systemic lupus erythematosus (SLE). However, although successfully confirmed to be useful in major large scale trials in RA and vasculitis, two SLE trials did not meet their endpoints. Given the widespread use of BCD in SLE it seems likely that it will continue to be used though better designed trials (which work) would help resolve on-going problems with regulatory and funding agencies.