Mechanism and Target Therapy of Rituximab in Systemic Lupus Erythematosus: Literature Review
DOI:
https://doi.org/10.23917/pharmacon.v22i1.8103Keywords:
Mechanism, Rituximab, SLE, Target Therapy, β CellsAbstract
The malignant condition known as lymphoma affects the lymphoid tissues, bone marrow, and blood. Between 2009 and 2013, the incidence rate of lymphoma in the United States was approximately 22 per 100,000 individuals. Hemolytic anemia, leukopenia, and thrombocytopenia are among the hematologic symptoms of systemic lupus erythematosus (SLE), a highly diverse disease. Rituximab (RTU) and other monoclonal antibodies that target β cells are used as off-label therapy for SLE. Rituximab is a human CD20-specific chimeric monoclonal antibody. Rituximab can be utilized as an alternate therapy for SLE in addition to providing treatment for lymphoma. Rituximab has demonstrated positive effects and potential as a treatment for SLE in several clinical trials. This study aims to elucidate the mechanism of action of rituximab as a therapeutic agent targeting β cells in patients with SLE. The methodology used in this study is a literature review. The literature retrieval and search strategies were conducted using electronic means. A literature review of seven periodicals was produced by employing keywords to retrieve scientific material using the Boolean approach. Rituximab depletes and inhibits the activation of β cells in individuals with systemic lupus erythematosus by binding to the Fc gamma IIβ receptor on both β cells and macrophages.
Downloads
References
Alamilla Sanchez, M. E., Alcala-Salgado, M. A., Alonso-Bello, C. D., & Fonseca Gonzalez, G. T. (2021). Mechanism of Action and Efficacy of Immunosupressors in Lupus Nephritis. International Journal of Nephrology and Renovascular Disease, 14, 441–458. https://doi.org/10.2147/IJNRD.S335371
An, Y., Zhang, H., & Liu, Z. (2019). Individualizing Therapy in Lupus Nephritis. Kidney International Reports, 4(10), 1366–1372. https://doi.org/10.1016/j.ekir.2019.08.005
Athanassiou, P., & Athanassiou, L. (2023). Current Treatment Approach, Emerging Therapies and New Horizons in Systemic Lupus Erythematosus. Life, 13(7), 1–20. https://doi.org/10.3390/life13071496
Banchereau, J., & Pascual, V. (2006). Type I Interferon in Systemic Lupus Erythematosus and Other Autoimmune Diseases. Immunity, 25(3), 383–392. https://doi.org/10.1016/j.immuni.2006.08.010
Basta, F., Fasola, F., Triantafyllias, K., & Schwarting, A. (2020). Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New. Rheumatology and Therapy, 7(3), 433–446. https://doi.org/10.1007/s40744-020-00212-9
Beckwith, H., & Lightstone, L. (2014). Rituximab in systemic lupus erythematosus and lupus nephritis. Nephron - Clinical Practice, 128, 250–254. https://doi.org/10.1159/000368585
Bello, C., & Sotomayor, E. M. (2007). Monoclonal antibodies for B-cell lymphomas: rituximab and beyond. Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, June, 233–242. https://doi.org/10.1182/asheducation-2007.1.233
Cambridge, G., Perry, H. C., Nogueira, L., Serre, G., Parsons, H. M., De La Torre, I., Dickson, M. C., Leandro, M. J., & Edwards, J. C. W. (2014). The effect of B-cell depletion therapy on serological evidence of B-cell and plasmablast activation in patients with rheumatoid arthritis over multiple cycles of rituximab treatment. Journal of Autoimmunity, 50, 67–76. https://doi.org/10.1016/j.jaut.2013.12.002
Crow, M. K. (2023). Pathogenesis of systemic lupus erythematosus: Risks, mechanisms and therapeutic targets. Annals of the Rheumatic Diseases, 82(8), 999–1014. https://doi.org/10.1136/ard-2022-223741
Dipiro, J. T., Yee, G. C., Posey, M., Haines, S. T., Nolin, T. D., & Ellingrod, V. (2021). Pharmacotherapy A Pathophysiologic Approach Eleventh Edition. In McGraw Hill (Eleventh). McGraw Hill. https://doi.org/10.1016/B978-0-323-69578-7.00013-2
Ehrenstein, M. R., & Shipa, M. (2023). SLE is not a one-size-fits-all disease. Journal of Experimental Medicine, 220(6), 1–4. https://doi.org/10.1084/jem.20230559
Eisenberg, R., & Looney, R. J. (2005). The therapeutic potential of anti-CD20: What do B-cells do? Clinical Immunology, 117(3), 207–213. https://doi.org/10.1016/j.clim.2005.08.006
Galanopoulos, N., Christoforidou, A., & Bezirgiannidou, Z. (2017). Lupus thrombocytopenia: pathogenesis and therapeutic implications. Mediterranean Journal of Rheumatology, 28(1), 20–26. https://doi.org/10.31138/mjr.28.1.20
Jordan, N., & D’Cruz, D. (2016). Current and emerging treatment options in the management of lupus. ImmunoTargets and Therapy, 9. https://doi.org/10.2147/itt.s40675
Kuppers, R., & Walker, J. M. (2013). Lymphoma Methods and Protocols. Human Press.
Leandro, M., & Isenberg, D. A. (2021). Rituximab – The first twenty years. Lupus, 30(3), 371–377. https://doi.org/10.1177/0961203320982668
Lee, W. S., & Amengual, O. (2020). B cells targeting therapy in the management of systemic lupus erythematosus. Immunological Medicine, 43(1), 16–35. https://doi.org/10.1080/25785826.2019.1698929
Levitsky, A., Linder, S., & Ronald, F. V. (2013). Rituximab in the management of systemic lupus erythematosus. Rheumatology Science and Practice, 0(3), 223. https://doi.org/10.14412/1995-4484-2013-1494
Mak, A., & Kow, N. Y. (2014). The pathology of t cells in systemic lupus erythematosus. Journal of Immunology Research, 2014. https://doi.org/10.1155/2014/419029
Matasar, M. J., & Zelenetz, A. D. (2008). Overview of Lymphoma Diagnosis and Management. Radiologic Clinics of North America, 46(2), 175–198. https://doi.org/10.1016/j.rcl.2008.03.005
Moroni, G., Raffiotta, F., Trezzi, B., Giglio, E., Mezzina, N., Del Papa, N., Meroni, P., Messa, P., & Sinico, A. R. (2014). Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: A clinical observational study. Rheumatology (United Kingdom), 53(9), 1570–1577. https://doi.org/10.1093/rheumatology/ket462
Mugnaini, E. N., & Ghosh, N. (2016). Lymphoma. Primary Care - Clinics in Office Practice, 43(4), 661–675. https://doi.org/10.1016/j.pop.2016.07.012
Ocampo-Piraquive, V., Nieto-Aristizábal, I., Cañas, C. A., & Tobón, G. J. (2018). Mortality in systemic lupus erythematosus: causes, predictors and interventions. Expert Review of Clinical Immunology, 14(12), 1043–1053. https://doi.org/10.1080/1744666X.2018.1538789
Parodis, I., Gatto, M., & Sjöwall, C. (2022). B cells in systemic lupus erythematosus: Targets of new therapies and surveillance tools. Frontiers in Medicine, 9(1). https://doi.org/10.3389/fmed.2022.952304
Pirone, C., Mendoza-Pinto, C., van der Windt, D. A., Parker, B., O׳Sullivan, M., & Bruce, I. N. (2017). Predictive and prognostic factors influencing outcomes of rituximab therapy in systemic lupus erythematosus (SLE): A systematic review. Seminars in Arthritis and Rheumatism, 47(3), 384–396. https://doi.org/10.1016/j.semarthrit.2017.04.010
Robinson, J. I., Md Yusof, M. Y., Davies, V., Wild, D., Morgan, M., Taylor, J. C., El-Sherbiny, Y., Morris, D. L., Liu, L., Rawstron, A. C., Buch, M. H., Plant, D., Cordell, H. J., Isaacs, J. D., Bruce, I. N., Emery, P., Barton, A., Vyse, T. J., Barrett, J. H., … Morgan, A. W. (2022). Comprehensive genetic and functional analyses of Fc gamma receptors influence on response to rituximab therapy for autoimmunity. EBioMedicine, 86. https://doi.org/10.1016/j.ebiom.2022.104343
Rosenzwajg, M., Languille, E., Debiec, H., Hygino, J., Dahan, K., Simon, T., Klatzmann, D., & Ronco, P. (2017). B- and T-cell subpopulations in patients with severe idiopathic membranous nephropathy may predict an early response to rituximab. Kidney International, 92(1), 227–237. https://doi.org/10.1016/j.kint.2017.01.012
Salles, G., Barrett, M., Foà, R., Maurer, J., O’Brien, S., Valente, N., Wenger, M., & Maloney, D. G. (2017). Rituximab in B-Cell Hematologic Malignancies: A Review of 20 Years of Clinical Experience. Advances in Therapy, 34(10), 2232–2273. https://doi.org/10.1007/s12325-017-0612-x
Sanz, I. (2016). Systemic lupus erythematosus: Extent and patterns of off-label use of rituximab for SLE. Nature Reviews Rheumatology, 12(12), 700–702. https://doi.org/10.1038/nrrheum.2016.191
Shen, C. J., & Terezakis, S. A. (2020). Lymphoma. In Medical Radiology. https://doi.org/10.1007/174_2016_70
Tian, J., Zhang, D., Yao, X., Huang, Y., & Lu, Q. (2023). Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study. Annals of the Rheumatic Diseases, 82(3), 351–356. https://doi.org/10.1136/ard-2022-223035
Weiner, G. J. (2010). Rituximab: Mechanism of action. Seminars in Hematology, 47(2), 115–123. https://doi.org/10.1053/j.seminhematol.2010.01.011
Wiesik-Szewczyk, E., & Olesinska, M. (2012). B-cell targeted therapy in systemic lupus erythematosus: Potential of rituximab. Biologics: Targets and Therapy, 6, 347–354. https://doi.org/10.2147/BTT.S25407
Witt, M., Grunke, M., Proft, F., Baeuerle, M., Aringer, M., Burmester, G., Chehab, G., Fiehn, C., Fischer-Betz, R., Fleck, M., Freivogel, K., Haubitz, M., Kötter, I., Lovric, S., Metzler, C., Rubberth-Roth, A., Schwarting, A., Specker, C., Tony, H. P., … Schulze-Koops, H. (2013). Clinical outcomes and safety of rituximab treatment for patients with systemic lupus erythematosus (SLE) - Results from a nationwide cohort in Germany (GRAID). Lupus, 22(11), 1142–1149. https://doi.org/10.1177/0961203313503912
Wu, S., Wang, Y., Zhang, J., Han, B., Wang, B., Gao, W., Zhang, N., Zhang, C., Yan, F., & Li, Z. (2020). Efficacy and safety of rituximab for systemic lupus erythematosutreatment: A meta-analysis. African Health Sciences, 20(2), 871–884. https://doi.org/10.4314/ahs.v20i2.41







