Efficacy of anti-CD20 treatment in patients with rheumatoid arthritis resistant to a combination of methotrexate/anti-TNF therapy

Scand J Immunol. 2007 Oct;66(4):476-83. doi: 10.1111/j.1365-3083.2007.01995.x.


Rheumatoid arthritis (RA) is characterized by chronic joint inflammation and destruction. B cells play important role in modulating immune responses in RA. In the present study we assessed the impact of the B cell targeting as a third line treatment option. Forty-six patients with established erosive RA non-responding to combination treatment with DMARDs and TNF-alpha inhibitors were treated with anti-CD20 antibodies (rituximab). Rituximab was given intravenously once weekly on four occasions. All patients continued with the previous DMARD. Patients were followed by DAS28, levels of circulating B cells, frequency of immunoglobulin-producing cells, immunoglobulins, and rheumatoid factor levels during the period of 12-58 months. Clinical improvement was achieved in 34 of 46 patients (73%) supported by a significant reduction in DAS28 (from 6.04 to 4.64, P < 0.001). Infusion of rituximab resulted in the elimination of circulating B cells in all but one patient. Within 12 months follow-up, B cells returned to circulation in 86% of patients. Fifty-three percent of the patients were successfully retreated with rituximab or re-started with anti-TNF-alpha treatment. Of the 11 non-responders, five were retreated with anti-CD20 within 2 months, four of them with success, four patients received TNF-alpha inhibitors, the remaining two patients received an additional DMARD. Most of the RA patients resistant to TNF-alpha inhibitors may be effectively treated with anti-CD20 antibodies. The treatment is well tolerated and may be used repeatedly in the same patient and potentially increase sensitivity to previously inefficient treatment modalities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20 / immunology*
  • Antirheumatic Agents / therapeutic use*
  • Arthralgia / drug therapy
  • Arthralgia / immunology
  • B-Lymphocytes / immunology*
  • Blood Sedimentation / drug effects
  • C-Reactive Protein / analysis
  • Drug Resistance
  • Female
  • Hemoglobins / analysis
  • Humans
  • Immunoglobulins / blood
  • Immunotherapy / methods*
  • Leukocyte Count
  • Longitudinal Studies
  • Male
  • Methotrexate / pharmacology
  • Middle Aged
  • Platelet Count
  • Rheumatic Fever / blood
  • Rheumatic Fever / immunology*
  • Rheumatic Fever / therapy
  • Rheumatoid Factor / blood
  • Rituximab
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • Antirheumatic Agents
  • Hemoglobins
  • Immunoglobulins
  • Tumor Necrosis Factor-alpha
  • Rituximab
  • C-Reactive Protein
  • Rheumatoid Factor
  • Methotrexate