Practical considerations on the use of rituximab in autoimmune neurological disorders

Abstract

Rituximab (Mabthera, Rituxan) is a chimeric human/murine monoclonal antibody against CD-20 surface antigen expressed on B-cells. Rituximab, by causing B-cell depletion, appears to be effective in several autoimmune disorders; it has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders. A controlled study in patients with relapsing remitting multiple sclerosis has shown that rituximab significantly reduces the number of new MRI lesions and improves clinical outcome; it also showed some promise in a subset of patients with primary progressive MS. The drug is also effective in a number of patients with Devic's disease, myasthenia gravis, autoimmune neuropathies, and inflammatory myopathies. The apparent effectiveness of rituximab has moved B-cells into the center stage of clinical and laboratory investigation of autoimmune neurological disorders. We review the evidence-based effectiveness of rituximab in neurological disorders based on controlled trials and anecdotal reports, including our own experience, and address the immunobiology of B-cells in autoimmune central nervous system (CNS) and peripheral nervous system (PNS) disorders. In addition, we provide practical guidelines on how best to use this drug in clinical practice and highlight its potential toxicity.

A molecular perspective on rituximab: A monoclonal antibody for B cell non Hodgkin lymphoma and other affections

“…Another study also showed rituximab resulted in effective clinical response in 79% Systemic lupus erythematosus (SLE) patients (Tokunaga et al, 2007). Kosmidis and Dalakas (2010) have summarized the effect of rituximab on some autoimmune neurological disorders improvement. They also concluded rituximab has positive effect on the treatment of autoimmune diseases.…”

Treatment and outcome of children and adolescents with N-methyl-d-aspartate receptor encephalitis

“…Given the presumed direct pathogenic role of NMDA-R-Abs in this disease, as suggested by experimental studies, and the characteristic perivascular clusters of B lymphocytes in the brains of patients with NMDA-R-Abs encephalitis, some authors have suggested that rituximab could be a useful treatment, with a better outcome when administered early in the disease [8,[11][12][13][14][15]. Rituximab depletes B cells from the circulation and from [16,17]. It has been used with increasing frequency in both systemic autoimmune diseases and neurological ones, such as myasthenia gravis, neuromyelitis optica, stiff man syndrome or opsoclonus-myoclonus syndrome in both adults and children [11,[18][19][20][21][22].…”

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

“…Treatment with rituximab thus selectively depletes B-lymphocytes, but not plasma cells [380]. The depletion of B-cells occurs through a combination of antibody dependent cell-mediated toxicity and complement-mediated cytotoxicity, and lasts for approximately 6 months [381].…”