Depletion of B lymphocyte cells might provide a new treatment for rheumatoid
arthritis, suggest United Kingdom researchers this week.
Professor Jonathan Edwards (Middlesex hospital, London) reported his findings
this week at the 64th annual meeting of the American College of Rheumatology
in Philadelphia, United States. According to an abstract from the meeting, the
work was based on a hypothesis that rheumatoid arthritis is propagated by B
lymphocytes and that depletion of B lymphocytes might induce remission, as long
as rheumatoid factor levels fall significantly before B lymphocytes return.
Professor Edwards conducted an initial trial in which B lymphocytes were depleted
in five patients using a monoclonal antibody (rituximab), prednisolone and cyclophosphamide.
Three patients had maintained or extended improvement at one year and showed
no sign of relapse. The other two patients relapsed at seven and nine months
but showed improvement after repeat B lymphocyte depletion. Relapses coincided
with the return of B lymphocytes and only occurred when levels of rheumatoid
factor remained high.
Further small trials showed similar responses and a controlled trial is likely
to follow.
Knoll’s fully human anti-TNF (tumour necrosis factor) antibody, D2E7, continues to show promise in the treatment of rheumatoid arthritis, according to phase III data presented at the ACR meeting. A study of 284 patients with rheumatoid arthritis showed that weekly doses of 20, 40 and 80mg were all statistically superior to placebo in reducing signs and symptoms of disease at three months and that clinical responses were sustained throughout one year of treatment.