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01-11-2019 | Rituximab | Review Article

A comprehensive review of rituximab therapy in rheumatoid arthritis patients

Authors: Soheil Tavakolpour, Samira Alesaeidi, Mohammad Darvishi, Mojtaba GhasemiAdl, Sahar Darabi-Monadi, Meisam Akhlaghdoust, Somayeh Elikaei Behjati, Arash Jafarieh

Published in: Clinical Rheumatology | Issue 11/2019

Abstract

Rituximab (RTX) is an approved treatment for rheumatoid arthritis (RA) patients that do not respond adequately to disease-modifying antirheumatic drugs. However, different new concerns, such as efficacy, optimum dose, safety issues, prediction of response to RTX, and pregnancy outcomes have attracted a lot of attention. The PubMed database was systematically reviewed for the last published articles, new findings, and controversial issues regarding RTX therapy in RA using “Rheumatoid arthritis” AND “rituximab” keywords, last updated on June 18, 2019. From 1812 initial recorders, 162 studies met the criteria. Regarding the optimum dose, low-dose RTX therapy (2 × 500 mg) seems as effective as standard dose (2 × 1000 mg), safer, and more cost-effective. The most common reported safety challenges included de novo infections, false negative serologic tests of viral infections, reactivation of chronic infections, interfering with vaccination outcome, and development of de novo psoriasis. Other less reported side effects are infusion reactions, nervous system disorders, and gastrointestinal disorders. Lower exposure to other biologics, presence of some serological markers (e.g., anti-RF, anti-CCP, IL-33, ESR), specific variations in FCGR3A, FCGR2A, TGFβ1, IL6, IRF5, BAFF genes, and also EBV-positivity could be used to predict response to RTX. Although there is no evidence of the teratogenic effect of RTX, it is recommended that women do not expose themselves to RTX at least 6 months before the conception. Only a reversible reduction of B cell-count in the offspring may be the pregnancy-related outcome. Although RTX is an effective therapeutic option for RA, more studies on optimum doses, prevention of RTX-related side effects, prediction of RTX response, and safety during the pregnancy are required.

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Title: A comprehensive review of rituximab therapy in rheumatoid arthritis patients
Authors: Soheil Tavakolpour
Samira Alesaeidi
Mohammad Darvishi
Mojtaba GhasemiAdl
Sahar Darabi-Monadi
Meisam Akhlaghdoust
Somayeh Elikaei Behjati
Arash Jafarieh
Publication date: 01-11-2019
Publisher: Springer London
Keywords: Rituximab
Rheumatoid Arthritis
Rituximab
Published in: Clinical Rheumatology / Issue 11/2019
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04699-8

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