Rituximab: The RA Smart-Bomb

Rheumatoid Arthritis affects approximately 1 percent of the adult population in the United States. The symptoms include joint inflammation, pain, and resultant fatigue. The illness' chronic nature makes the general activities of life difficult. The exact cause and development of RA is unknown, but according to the June 17th, 2004 issue of the New England Journal of Medicine, strong evidence for a critical role of B cells came from a small open-label study of rituximab (rituxan).

Rituximab has already been proven to be of immense value in treating a variety of other diseases in which B cell activity plays a primary role, and its use in non-Hodgkin's lymphoma has revolutionized the current approach to treatment. Increasingly, rituximab has been utilized to deplete B cell populations in non-malignant diseases, especially those illnesses which have been designated autoimmune in nature. Lupus erythematosus, autoimmune hemolysis, the antiphospholipid syndrome, idiopathic thrombocytopenic purpura are some of the conditions which have been successfully treated by this agent. Now, based upon recent work which has implicated certain B cells in the destructive processes of rheumatoid arthritis, rituximab has been shown to be beneficial in lessening the destructive immune activity which is the basis of the disease. This NEJM article is amongst the first to corroborate this benefit, and the study (randomized, double-blinded) was both well-conceived and executed.

The group randomly assigned 161 patients who had active rheumatoid arthritis despite treatment with methotrexate to receive one of four treatments: oral methotrexate ( 10 mg per week) (control); rituximab (1000 mg on days 1 and 15); rituximab plus cyclophosphamide (750 mg on days 3 and 17); or rituximab plus methotrexate. In patients with active rheumatoid arthritis despite methotrexate treatment, a single course of two infusions of rituximab, alone or in combination with either cyclophosphamide or continued methotrexate, provided significant improvement in disease symptoms.

This study shows that this new avenue of treatment successfully disrupts rheumatoid activity. The results hold great promise for the future of treatment, and as treatment options increase, the benefits are clear for the patients.