What´s Rituximab Therapy? Essay -- Alternate Treatment, Biology, Antib

A relatively newer biologic, rituximab provides an alternative strategy for treating the presenting patient. A genetically engineered chimeric anti-CD20 monoclonal antibody, rituximab exerts it therapeutic action by selectively targeting CD-20 positive B-cells1212, 18. As CD-20 is expressed exclusively on pre-B and mature B lymphocytes; stem cells and plasma cells are not implicated in rituximab therapy. The over expression of B-cells expressing the CD-20 surface antigen in the synovium of RA-affected joints has been well established18. The potential mechanisms by which these B-cells contribute to the immunopathogenesis of RA are as follows: they can act as antigen presenting cells, secrete pro-inflammatory cytokines (including tumour necrosis factor-alpha), and generate rheumatoid factor (RF) and other auto-antibodies whilst also activating T cells12. Hence, the rituximab mediated depletion of B-cells is thought to prevent these potential mechanisms from occurring thus controlling the progression of the disease18. Rituximab therapy consists of two 1000mg infusions, given two weeks apart at intervals of no less than 2 weeks. The projected cost of a single course of rituximab therapy is around  £349211 and if clinically efficient would offer the patient a more convenient dosing schedule compared to Anti-TNF therapy. The annual cost does however depend on how often the patient is required to undergo a course of rituximab therapy11. An RCT aimed at investigating different rituximab dosing regimens in methotrexate resistant patients referred to as the DANCER trial, provides significant evidence conveying the potential benefit of rituximab therapy19. As part of the trial, patients received rituximab 500MG, rituximab 1000mg or placeb... ...50 (7): 754--766. 27. Kaneko A. Tocilizumab in rheumatoid arthritis: efficacy, safety and its place in therapy.Therapeutic advances in chronic disease. 2013; 4 (1): 15--21. 28. An M, Zou Z, Shen H, Zhang J, Cao Y, Jiang Y. The addition of tocilizumab to DMARD therapy for rheumatoid arthritis: a meta-analysis of randomized controlled trials. European journal of clinical pharmacology. 2010; 66 (1): 49--59. 29. Schmitt C, Kuhn B, Zhang X, Kivitz A, Grange S. Disease--drug--drug interaction involving tocilizumab and simvastatin in patients with rheumatoid arthritis. Clinical Pharmacology & Therapeutics. 2011; 89 (5): 735--740. 30. Ding T, Ledingham J, Luqmani R, Westlake S, Hyrich K, Lunt M, Kiely P, Bukhari M, Abernethy R, Bosworth A, Others. BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies.Rheumatology. 2010; 49 (11): 2217--2219.