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001-es BibID:BIBFORM044047
Első szerző:Váncsa Andrea (orvos)
Cím:Longterm effects of rituximab on B cell counts and autoantibody production in rheumatoid arthritis : use of high-sensitivity flow cytometry for more sensitive assessment of B cell depletion / Andrea Váncsa, Zoltán Szabó, Szilvia Szamosi, Nóra Bodnár, Edit Végh, Lajos Gergely, Gabriella Szucs, Sándor Szántó, Zoltán Szekanecz
Megjegyzések:OBJECTIVE:To assess the efficacy and safety of longterm rituximab (RTX) therapy for rheumatoid arthritis (RA) and study correlations among B cell depletion, clinical response, and autoantibody production.METHODS:Seventy-seven patients with moderate or high RA activity received RTX and were re-treated every 6 months regardless of clinical response. All patients received at least 5 cycles. We assessed 28-joint Disease Activity Score (DAS28), IgM rheumatoid factor (RF), and anticitrullinated protein antibody (ACPA) levels at baseline, after 15 days, and then every 6 months for 24 months. Absolute CD19+ B lymphocyte counts were determined in 50 patients using high-sensitivity flow cytometry (hsFACS) by reading 100,000 events.RESULTS:After 6, 12, 18, and 24 months, 51.6%, 51.9%, 73.3%, and 83.8% of patients, respectively, showed good European League Against Rheumatism responses. Significant and sustained decreases in IgM RF and ACPA levels were observed as early as 6 months and 12 months, respectively. The baseline mean absolute B cell number was 0.234 g/l. B cell numbers diminished significantly after the very first infusion by Day 15 (0.104 g/l; p = 0.007); they further decreased until 24 months (0.0013 g/l; p < 0.001). One RTX infusion resulted in incomplete depletion in 76.7% of patients. Upon RTX treatment, changes in CD19+ B cell numbers positively correlated with changes in DAS28 (r = 0.963, p = 0.008) and IgM RF (r = 0.859, p = 0.028), but not with changes in ACPA production (r = 0.726, p = 0.102). The correlations between B cell numbers and DAS28 were observed in both ACPA-seropositive (r = 0.999, p < 0.0001) and ACPA-negative patient subpopulations (r = 0.962, p = 0.009). The correlation between CD19+ cell numbers and IgM RF was observed only in the ACPA-positive population (r = 0.944, p = 0.005) but not in seronegative patients (r = 0.398, p = 0.435). No safety issues arose.CONCLUSION:In RA, clinical response to RTX is associated with the extent of B cell depletion and with autoantibody production. Changes in CD19+ B cell numbers correlate with those in disease activity and, in seropositive patients, also with IgM RF, but not with ACPA production. We found that hsFACS may be a useful method to more accurately assess incomplete B cell depletion.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
B Cell Counts
Autoantibody Production
Rheumatoid Arthritis
Megjelenés:Journal of Rheumatology. - 40 : 5 (2013), p. 565-571. -
További szerzők:Szabó Zoltán (1970-) (belgyógyász, reumatológus) Szamosi Szilvia (1975-) (belgyógyász, reumatológus) Bodnár Nóra (1980-) (reumatológus) Végh Edit (1978-) (reumatológus, belgyógyász) Gergely Lajos (1965-) (belgyógyász, haematológus) Szűcs Gabriella (1963-) (belgyógyász, allergológus és klinikai immunológus, reumatológus) Szántó Sándor (1968-) (belgyógyász, reumatológus) Szekanecz Zoltán (1964-) (reumatológus, belgyógyász, immunológus)
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