Investigators review rituximab for the treatment of various autoimmune rheumatic diseases to determine how useful it is for approved and off-label use.
Improved understanding of autoimmune rheumatic diseases, such as rheumatoid arthritis, has helped advance the types of therapeutic options available. For example, biologic therapies are very promising and can greatly improve patients’ quality of life. Biologic therapies are naturally-sourced, medicinal products typically obtained from living cell lines. One such therapy, rituximab, is a monoclonal antibody that reduces inflammation and tissue damage by interacting with cells of the immune system.
Rituximab was first used to treat non-Hodgkin’s lymphoma and was later approved to treat rheumatoid arthritis and antineutrophil cytoplasmic antibody ANCA-associated vasculitis. Rituximab is currently used in “off-label” treatment of patients with systemic sclerosis, Sjögren’s syndrome, and systemic lupus erythematosus.
A paper published by Italian researchers in Drug Design, Development, and Therapy reviewed the current data regarding rituximab in the treatment of various autoimmune rheumatic diseases: rheumatoid arthritis, ANCA-associated vasculitis, systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, spondyloarthritis, and idiopathic inflammatory myopathies. They found that rituximab is effective in many, but not all, cases of the aforementioned conditions.
Rituximab is effective in treating rheumatoid arthritis, with clinical studies showing that patients significantly improved with treatment overall. Similarly, one course of rituximab was found to be as effective as continuous, conventional immunosuppressive treatment for ANCA-associated vasculitis. Rituximab is often used to treat systemic lupus erythematosus (SLE) despite being unapproved for the condition. Clinical studies show mixed results, but rituximab is still recommended for treating lupus-related kidney inflammation by the American College of Rheumatology. Similarly, in studies of patients with Sjögren’s syndrome, treatment with rituximab was found to be helpful overall, but some clinical trials did not report significant improvements.
For the treatment of systemic sclerosis, spondyloarthritis, and idiopathic inflammatory myopathies, more data are needed. While many clinical trials of rituximab and these conditions are underway, it is too soon to draw definitive conclusions about the effectiveness of rituximab.
Overall, rituximab is considered reasonably safe for the treatment of some rheumatic diseases, including rheumatoid arthritis and ANCA-associated vasculitis. More study is needed to determine efficacy and dosage in diseases other than rheumatoid arthritis and vasculitis.
Written by Cindi A. Hoover, Ph.D.
Reference: Schioppo T and Ingegnoli F. Current perspective on rituximab in rheumatic diseases. Drug Design, Development, and Therapy. 2017; 11:2891-2904.