Lessons for rituximab therapy in patients with rheumatoid arthritis

Garcia-Montoya, Leticia; Villota‐Eraso, Catalina; Yusof, Yuzaiful Md; Vital, Edward M; Emery, Paul

doi:10.1016/s2665-9913(20)30033-3

Cited by 29 publications

(21 citation statements)

References 71 publications

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“…autoimmune conditions vs. lymphoma) also given the significant heterogeneity in treatment schedules, intensity of anti-CD20 administration and previous treatments history [ 28 , 29 ]. As an example, in patients with systemic autoimmune diseases Rituximab is usually administered as two 1000 mg flat doses given 2 weeks apart, while in thrombocytopenic purpura scheduling usually consists of four weekly infusions of rituximab at a dose of 375 mg/m 2 [ 30 – 32 ]. Moreover, corticosteroids and or/methotrexate can be concurrently administered [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…As an example, in patients with systemic autoimmune diseases Rituximab is usually administered as two 1000 mg flat doses given 2 weeks apart, while in thrombocytopenic purpura scheduling usually consists of four weekly infusions of rituximab at a dose of 375 mg/m 2 [ 30 – 32 ]. Moreover, corticosteroids and or/methotrexate can be concurrently administered [ 32 ]. In NHL, anti-CD20 antibodies are always dosed at 375 mg/m 2 and given, together with alkylators-containing chemotherapy, at a three-weekly frequence for six courses followed, in the case of indolent NHLs, by a maintenance phase of bi-monthly administrations for 2 years [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab

Marcacci

Fiorentino²,

Volzone

et al. 2021

Infect Agents Cancer

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Patients with non-hodgkin lymphomas (NHL) represent a population of special interest during the current Coronavirus disease-19 (COVID-19) pandemics. NHLs are associated with disease- and treatment-related immunodeficiencies which may generate unusual COVID-19 dynamics and pose unique management challenges. We report the unusual clinical course of COVID-19 in a patient with mantle cell lymphoma (MCL) exposed to nine doses of Rituximab shortly before infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). He had a prolonged asymptomatic phase, with negative molecular and antibody testing for SARS-CoV-2, followed by a rapidly progressive evolution to severe COVID-19. Despite detection of viral RNA overlapped with first symptoms occurrence, anti-SARS-CoV-2 antibodies displayed an asynchronous pattern, with IgG first appearing 2 days after RNA positivity and IgM never being detected throughout the entire clinical course. While disease-associated immune derangements and/or previous treatments involving anti-CD20 antibodies might have contributed to COVID-19 dynamics in our patient, data suggests that antibody testings, without concurrent molecular assessment for SARS-CoV-2, may turn inadequate for monitoring of MCL patients, and in general NHL patients heavily exposed to anti-CD20 antibodies, during the current pandemics. We suggest that repeated molecular testing of nasopharyngeal swab should be implemented in these subjects despite a negative serology and absence of symptoms of SARS-CoV-2 infection. For the same reasons, a customized strategy needs to be developed for patients exposed to anti-CD20 antibodies, based on different features and mechanism of action of available SARS-CoV-2 vaccines and novel vaccinomics developments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab

Marcacci

Fiorentino²,

Volzone

et al. 2021

Infect Agents Cancer

View full text Add to dashboard Cite

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“… 62 , 63 Most patients with severe neutropenia recover quickly, and there is no evidence that the condition worsens with further treatment cycles. 64 The cause of LON has been poorly investigated and many theories have been formulated; the most credited hypotheses is that homeostasis of granulocytes may be disturbed by chemokine stromal-derived factor-1 interacting with B-lymphocyte recovery. 65 In the PPMS clinical trial with ocrelizumab, decreased neutrophil counts were transiently found in 13% of patients compared to 10% in placebo.…”

Section: Safety and Tolerability Datamentioning

confidence: 99%

Ocrelizumab for the Treatment of Multiple Sclerosis: Safety, Efficacy, and Pharmacology

Mancinelli¹,

Rossi²,

Capra³

2021

TCRM

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The success of selective B-cells depleting therapies, as the anti-CD20 antibodies, in patients with multiple sclerosis (MS) has confirmed that B-cells are critical in the immune pathogenesis of the disease. Ocrelizumab, a humanized monoclonal antibody that selectively targets CD20+ B-cells, profoundly suppresses acute inflammatory disease activity, representing a highly effective therapy for relapsing-remitting multiple sclerosis (RRMS). It is also the first proven therapy able to slow disability progression in primary progressive multiple sclerosis (PPMS), particularly in patients with signs of acute radiological activity before being enrolled. Effectiveness has widely been demonstrated in randomized clinical trials (RCTs), and recently confirmed in open-label extension trials. Here, we review the role of B-cells in MS, the mechanism of action of ocrelizumab, its pharmacokinetics and pharmacodynamics, and the clinical data supporting its use, as well as safety data. We focus on issues related to the maintenance of immunocompetence, essential to ensure an immune response to either a primary infection or a vaccination. Lastly, we discuss about the possible role of ocrelizumab as an exit strategy from natalizumab-treated patients at risk of developing multifocal progressive leukoencephalopathy. In view of using ocrelizumab chronically, collecting long-term safety data and finding strategies to minimize adverse events will be extremely relevant.

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“…[48] Rituximab is one of the main B cells targeting monoclonal antibody agents (mAB) frequently used in managing neuroinflammatory disorders by acting as anti-CD20 mAB. [49,50] The expression of CD20 molecule is associated with B cell maturation, rituximab works effectively by depleting pre-B and memory B cells. [50] The use of rituximab can be considered as one of the highest risk agents to be used in hindering COVID-19 pandemic infection due to its toxic and dangerous side effects with a recommendation on considering the delay of rituximab treatment initiation in managing COVID-19 neurological symptoms.…”

Section: The Impact Of Immunotherapies In Managing Neurological Manifmentioning

confidence: 99%

Immunotherapies and COVID-19 related Neurological manifestations: A Comprehensive Review Article

Anwar

2020

Journal of Immunoassay and Immunochemistry

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In December 2019, an outbreak of pandemic severe respiratory distress syndrome coronavirus disease 2019 (COVID-19) initially occurred in China, has spread the world resulted in serious threats to human public health. Uncommon neurological manifestations with pathophysiological symptoms were observed in infected patients including headache, seizures, and neuroimmunological disorders. Regardless of whether these neurological symptoms are direct or indirect casual infection relationship, this novel viral infection has a relevant impact on the neuroimmune system that requires a neurologist's careful assessment. Recently, the use of immunotherapy has been emerged in fighting against COVID-19 infection despite the uncertain efficiency in managing COVID-19 related disorders or even its proven failure by increasing its severity. Herein, the author is addressing the first approaches in using immunotherapies in controlling COVID-19 viral impact on the brain by highlighting their role in decreasing or increasing infection risks among subjects. This point of view review article supports the use of immunotherapies in managing COVID-19 neurological disorders but in optimal timing and duration to ensure the maximum therapeutic outcome by reducing morbidity and mortality rate. Based on recently published data, the current review article highlights the beneficial effects and drawbacks of using immunotherapies to combat COVID-19 and its neurological symptoms.

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Lessons for rituximab therapy in patients with rheumatoid arthritis

Cited by 29 publications

References 71 publications

Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab

Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab

Ocrelizumab for the Treatment of Multiple Sclerosis: Safety, Efficacy, and Pharmacology

Immunotherapies and COVID-19 related Neurological manifestations: A Comprehensive Review Article

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