Garcia-Montoya Leticia, Villota-Eraso Catalina, Yusof Md Yuzaiful Md, Vital Edward M, Emery Paul
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK; National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia.
Lancet Rheumatol. 2020 Aug;2(8):e497-e509. doi: 10.1016/S2665-9913(20)30033-3. Epub 2020 May 12.
B-cell depletion therapy is an effective option for the treatment of rheumatoid arthritis but often does not result in complete B-cell depletion. Complete B-cell depletion after rituximab treatment is associated with clinical response, and this outcome leads to long-term maintenance of therapy. Low pretreatment plasmablast counts, concomitant treatment with disease-modifying antirheumatic drugs, no smoking exposure, the presence of anticitrullinated protein antibodies or rheumatoid factor, and a low interferon signature are all predictive of complete B-cell depletion and clinical response. Half of patients who initially show complete B-cell depletion and clinical response after rituximab treatment eventually lose responsiveness with further infusions. However three-quarters of these patients regain this outcome in their following treatment cycle, suggesting that loss of response is reversible and that patients can still benefit from rituximab retreatment. The efficacy of reduced doses of rituximab is being investigated, but preliminary results suggest that these strategies are best used for maintenance therapy, particularly in patients who suffer adverse events or who are at a high risk of infection. Infusion-related reactions are the most common adverse events associated with rituximab treatment, and monitoring of IgG concentrations is crucial, as low concentrations are correlated with an increased risk of infection.
B细胞清除疗法是治疗类风湿性关节炎的一种有效选择，但通常不会导致B细胞完全清除。利妥昔单抗治疗后B细胞完全清除与临床反应相关，这一结果可带来长期的治疗维持。治疗前浆母细胞计数低、同时使用改善病情的抗风湿药物、无吸烟史、存在抗瓜氨酸化蛋白抗体或类风湿因子以及干扰素特征低，均预示着B细胞完全清除和临床反应。最初在利妥昔单抗治疗后表现出B细胞完全清除和临床反应的患者中，有一半最终会在进一步输注后失去反应性。然而，这些患者中有四分之三在随后的治疗周期中恢复了这一结果，这表明反应丧失是可逆的，患者仍可从利妥昔单抗再治疗中获益。正在研究降低剂量利妥昔单抗的疗效，但初步结果表明，这些策略最适合用于维持治疗，尤其是那些发生不良事件或感染风险高的患者。输注相关反应是与利妥昔单抗治疗相关的最常见不良事件，监测IgG浓度至关重要，因为低浓度与感染风险增加相关。
