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B cell depletion with rituximab in the treatment of primary Sjögren’s syndrome: what have we learnt?

1, 2, 3, 4, 5, 6

 

  1. Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, UK.
  2. Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, and Department of Oral Medicine, Institute of Dentistry, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
  3. Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, UK.
  4. Department of Oral Medicine, Institute of Dentistry, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
  5. Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, and Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  6. Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, UK. m.bombardieri@qmul.ac.uk

CER12517
2019 Vol.37, N°3 ,Suppl.118
PI 0217, PF 0224
Reviews

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PMID: 31464681 [PubMed]

Received: 19/06/2019
Accepted : 11/07/2019
In Press: 28/08/2019
Published: 28/08/2019

Abstract

Despite the well-established role of B cells in the pathogenesis of primary Sjögren’s syndrome (pSS), the beneficial role of B-cell depletion therapy with rituximab remains elusive in this condition, contrary to other autoimmune diseases. Although early, small-scale studies showed promising results, two recent large randomised controlled trials did not meet their primary end-points. It is evident from most trials that rituximab has a positive impact on B-cell numbers and activity, both in the peripheral blood and in salivary glands, but clinical outcomes vary among studies. We review here the evidence to date of B-cell depletion in pSS, analysing the underlying causes for the discrepancies in different studies and their limitations. We also discuss the potential use of peripheral and salivary gland biomarkers for patient stratification and targeted patient selection. Overall, rituximab remains a plausible treatment for pSS provided future studies address the shortfalls that emerged from our current knowledge of the use of B-cell depletion in this condition.

Rheumatology Article