- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China;
Rituximab (RTX) is a monoclonal antibody directed against the CD20 antigen expressed on B cells. It has been successfully employed in the treatment of non-Hodgkin's lymphoma and varied systemic autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and granulomatosis with polyangiitis. Recently its efficacy in the treatment of ocular inflammatory diseases (OID), including refractory scleritis, peripheral ulcerative keratitis, uveitis, and ocular cicatricial pemphigoid, has aroused more concerns. The literature suggests that RTX may be useful for controlling the inflammation and decreasing or stopping the use of corticosteroids and other immunosuppressants in OID, which may contribute a new treatment alternative in patients with the recalcitrant and sight-threatening forms of OID. This article reviews the clinical application status of RTX in the treatment of OID.
Citation: You Caiyun, Chen Song, Yan Hua. Advance of rituximab in the treatment of ocular inflammatory diseases. Chinese Journal of Ocular Fundus Diseases, 2018, 34(5): 503-507. doi: 10.3760/cma.j.issn.1005-1015.2018.05.022 Copy
1. | Cultrera JL, Dalia SM. Diffuse large B-cell lymphoma: current strategies and future directions[J]. Cancer Control, 2012, 19(3): 204-213. DOI: 10.1177/107327481201900305. |
2. | Caporali R, Caprioli M, Bobbio-Pallavicini F, et al. Long term treatment of rheumatoid arthritis with rituximab[J]. Autoimmun Rev, 2009, 8(7): 591-594. DOI: 10.1016/j.autrev.2009.02.008. |
3. | Edwards JC, Leandro MJ, Cambridge G. B lymphocyte depletion therapy with rituximab in rheumatoid arthritis[J]. Rheum Dis Clin North Am, 2004, 30(2): 393-403. DOI: 10.1016/j.rdc.2004.01.006. |
4. | Kiely PD, Deighton C, Dixey J, et al. Biologic agents for rheumatoid arthritis:negotiating the NICE technology appraisals[J]. Rheumatology (Oxford), 2012, 51(1): 24-31. DOI: 10.1093/rheumatology/ker321. |
5. | Conti F, Perricone C, Ceccarelli F, et al. Rituximab treatment of systemic lupus erythematosus in controlled trials and in clinical practice: two sides of the same coin[J]. Autoimmun Rev, 2010, 9(11): 716-720. DOI: 10.1016/j.autrev.2010.07.013. |
6. | Stasi R, Stipa E, Del Poeta G, et al. Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab[J]. Rheumatology (Oxford), 2006, 45(11): 1432-1436. DOI: 10.1093/rheumatology/kel098. |
7. | Rhee EP, Laliberte KA, Niles JL. Rituximab as maintenance therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis[J]. Clin J Am Soc Nephrol, 2010, 5(8): 1394-1400. DOI: 10.2215/CJN.08821209. |
8. | Roubaud-Baudron C, Pagnoux C, Méaux-Ruault N, et al. Rituximab maintenance therapy for granulomatosis with polyangiitis and microscopic polyangiitis[J]. J Rheumatol, 2012, 39(1): 125-130. DOI: 10.3899/jrheum.110143. |
9. | Foster CS, Chang PY, Ahmed AR. Combination of rituximab and intravenous immunoglobulin for recalcitrant ocular cicatricial pemphigoid: a preliminary report[J]. Ophthalmology, 2010, 117(5): 861-869. DOI: 10.1016/j.ophtha.2009.09.049. |
10. | Anhalt GJ, Morrison LH. Bullous and cicatricial pemphigoid[J].J Autoimmun, 1991, 4(1): 17-35. |
11. | You C, Lamba N, Lasave AF, et al. Rituximab in the treatment of ocular cicatricial pemphigoid: a retrospective cohort study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(6): 1221-1228. DOI: 10.1007/s00417-017-3603-3. |
12. | Meijer JM, Meiners PM, Vissink A, et al. Effectiveness of rituximab treatment in primary Sjögren's syndrome: a randomized, double-blind, placebo-controlled trial[J]. Arthritis Rheum, 2010, 62(4): 960-968. DOI: 10.1002/art.27314. |
13. | Ebrahimiadib N, Modjtahedi BS, Roohipoor R, et al.Successful treatment strategies in granulomatosis with polyangiitis-associated peripheral ulcerative keratitis[J].Cornea, 2016, 35(11): 1459-1465. DOI: 10.1097/ICO.0000000000000919. |
14. | Guindolet D, Reynaud C, Clavel G, et al. Management of severe and refractory Mooren's ulcers with rituximab[J]. Br J Ophthalmol, 2017, 101(4): 418-422. DOI: 10.1136/bjophthalmol-2016-308838. |
15. | Kurz PA, Suhler EB, Choi D, et al. Rituximab for treatment of ocular inflammatory disease: a series of four cases[J].Br J Ophthalmol, 2009, 93(4): 546-548. DOI: 10.1136/bjo.2007.133173. |
16. | Lasave AF, You C, Ma L, et al. Long-term outcomes of rituximab therapy in patients with noninfectious posterior uveitis refractory to conventional immunosuppressive therapy[J]. Retina, 2018, 38(2): 395-402. DOI: 10.1097/IAE.0000000000001563. |
17. | Davatchi F, Shams H, Rezaipoor M, et al. Rituximab in intractable ocular lesions of Behcet's disease; randomized single-blind control study (pilot study)[J]. Int J Rheum Dis, 2010, 13(3): 246-252. DOI: 10.1111/j.1756-185X.2010.01546.x. |
18. | Perosa F, Favoino E, Caragnano MA, et al. CD20: a target antigen for immunotherapy of autoimmune diseases[J]. Autoimmun Rev, 2005, 4(8): 526-531. DOI: 10.1016/j.autrev.2005.04.004. |
19. | Bonavida B. What signals are generated by anti-CD20 antibody therapy?[J]. Curr Hematol Malig Rep, 2006, 1(4): 205-213. DOI: 10.1007/s11899-006-0001-z. |
20. | Perosa F, Prete M, Racanelli V, et al. CD20-depleting therapy in autoimmune diseases: from basic research to the clinic[J].J Intern Med, 2010, 267(3): 260-277. DOI: 10.1111/j.1365-2796.2009.02207.x. |
21. | Arkfeld DG. The potential utility of B cell-directed biologic therapy in autoimmune diseases[J]. Rheumatol Int, 2008, 28(3): 205-215. DOI: 10.1007/s00296-007-0471-x. |
22. | Dörner T, Lipsky PE. B-cell targeting: a novel approach to immune intervention today and tomorrow[J].Expert Opin Biol Ther, 2007, 7(9): 1287-1299. DOI: 10.1517/14712598.7.9.1287. |
23. | Smith JR, Stempel AJ, Bharadwaj A, et al. Involvement of B cells in non-infectious uveitis[J]. Clin Transl Immunology, 2016, 5(2): 63. DOI: 10.1038/cti.2016.2. |
24. | Heiligenhaus A, Miserocchi E, Heinz C, et al. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab)[J]. Rheumatology (Oxford), 2011, 50(8): 1390-1394. DOI: 10.1093/rheumatology/ker107. |
25. | Miserocchi E, Pontikaki I, Modorati G, et al. Rituximab for uveitis[J].Ophthalmology, 2011, 118(1): 223-224. DOI: 10.1016/j.ophtha.2010.07.031. |
26. | Parikh JG, Tawansy KA, Rao NA. Immunohistochemical study of chronic nongranulomatous anterior uveitis in juvenile idiopathic arthritis[J]. Ophthalmology, 2008, 115(10): 1833-1836. DOI: 10.1016/j.ophtha.2008.03.027. |
27. | Nguyen QD, Humphrey RL, Dunn JP, et al. Elevated vitreous concentration of monoclonal immunoglobulin manifesting as schlieren in juvenile rheumatoid arthritis-associated uveitis[J]. Arch Ophthalmol, 2001, 119(2): 293-296. |
28. | Shimada H, Yuzawa M, Hirose T, et al. Pathological findings of multifocal choroiditis with panuveitis and punctate inner choroidopathy[J].Jpn J Ophthalmol, 2008, 52(4): 282-288. DOI: 10.1007/s10384-008-0566-2. |
29. | Xu C, Ricciuti A, Caturegli P, et al. Autoimmune lymphocytic hypophysitis in association with autoimmune eye disease and sequential treatment with infliximab and rituximab[J].Pituitary, 2015, 18(4): 441-447. DOI: 10.1007/s11102-014-0592-7. |
30. | Saouli Z, Papadopoulos A, Kaiafa G, et al. A new approach on bullous pemphigoid therapy[J]. Ann Oncol, 2008, 19(4): 825-826. DOI: 10.1093/annonc/mdn046. |
31. | Reguiaï Z, Tchen T, Perceau G, et al.Efficacy of rituximab in a case of refractory bullous pemphigoid[J]. Ann Dermatol Venereol, 2009, 136(5): 431-434. DOI: 10.1016/j.annder.2008.10.038. |
32. | Schmidt E, Seitz CS, Benoit S, et al. Rituximab in autoimmune bullous diseases: mixed responses and adverse effects[J].Br J Dermatol, 2007, 156(2): 352-356. DOI: 10.1111/j.1365-2133.2006.07646.x. |
33. | Schumann T, Schmidt E, Booken N, et al. Successful treatment of mucous membrane pemphigoid with the anti-CD-20 antibody rituximab[J]. Acta Derm Venereol, 2009, 89(1): 101-102. DOI: 10.2340/00015555-0560. |
34. | Rübsam A, Stefaniak R, Worm M, et al. Rituximab preserves vision in ocular mucous membrane Pemphigoid[J]. Expert Opin Biol Ther, 2015, 15(7): 927-933. DOI: 10.1517/14712598.2015.1046833. |
35. | Hardy S, Hashemi K, Catanese M, et al. Necrotising scleritis and peripheral ulcerative keratitis associated with rheumatoid arthritis treated with rituximab[J]. Klin Monbl Augenheilkd, 2017, 234(4): 567-570. DOI: 10.1055/s-0042-121315. |
36. | Huerva V, Sanchez MC, Traveset A, et al. Rituximab for peripheral ulcerative keratitis with wegener granulomatosis[J].Cornea, 2010, 29(6): 708-710. DOI: 10.1097/ICO.0b013e3181c296ed. |
37. | Freidlin J, Wong IG, Acharya N. Rituximab treatment for peripheral ulcerative keratitis associated with Wegener's granulomatosis[J].Br J Ophthalmol, 2007, 91(10): 1414. DOI: 10.1136/bjo.2006.113316. |
38. | Baslund B, Wiencke AK, Rasmussen N, et al. Treatment of orbital inflammation with rituximab in Wegener's granulomatosis[J].Clin Exp Rheumatol, 2012, 30(1 Suppl 70): S7-10. |
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40. | Joshi L, Lightman SL, Salama AD, et al. Rituximab in refractory ophthalmic Wegener's granulomatosis: PR3 titers may predict relapse, but repeat treatment can be effective[J]. Ophthalmology, 2011, 118(12): 2498-2503. DOI: 10.1016/j.ophtha.2011.06.009. |
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42. | Cousins SW, McCabe MM, Danielpour D, et al. Identification of transforming growth factor-beta as an immunosuppressive factor in aqueous humor[J].Invest Ophthalmol Vis Sci, 1991, 32(8): 2201- 2211. |
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44. | Ahmadi-Simab K, Lamprecht P, Nölle B, et al. Successful treatment of refractory anterior scleritis in primary Sjogren's syndrome with rituximab[J]. Ann Rheum Dis, 2005, 64(7): 1087-1088. DOI: 10.1136/ard.2004.027128. |
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- 1. Cultrera JL, Dalia SM. Diffuse large B-cell lymphoma: current strategies and future directions[J]. Cancer Control, 2012, 19(3): 204-213. DOI: 10.1177/107327481201900305.
- 2. Caporali R, Caprioli M, Bobbio-Pallavicini F, et al. Long term treatment of rheumatoid arthritis with rituximab[J]. Autoimmun Rev, 2009, 8(7): 591-594. DOI: 10.1016/j.autrev.2009.02.008.
- 3. Edwards JC, Leandro MJ, Cambridge G. B lymphocyte depletion therapy with rituximab in rheumatoid arthritis[J]. Rheum Dis Clin North Am, 2004, 30(2): 393-403. DOI: 10.1016/j.rdc.2004.01.006.
- 4. Kiely PD, Deighton C, Dixey J, et al. Biologic agents for rheumatoid arthritis:negotiating the NICE technology appraisals[J]. Rheumatology (Oxford), 2012, 51(1): 24-31. DOI: 10.1093/rheumatology/ker321.
- 5. Conti F, Perricone C, Ceccarelli F, et al. Rituximab treatment of systemic lupus erythematosus in controlled trials and in clinical practice: two sides of the same coin[J]. Autoimmun Rev, 2010, 9(11): 716-720. DOI: 10.1016/j.autrev.2010.07.013.
- 6. Stasi R, Stipa E, Del Poeta G, et al. Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab[J]. Rheumatology (Oxford), 2006, 45(11): 1432-1436. DOI: 10.1093/rheumatology/kel098.
- 7. Rhee EP, Laliberte KA, Niles JL. Rituximab as maintenance therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis[J]. Clin J Am Soc Nephrol, 2010, 5(8): 1394-1400. DOI: 10.2215/CJN.08821209.
- 8. Roubaud-Baudron C, Pagnoux C, Méaux-Ruault N, et al. Rituximab maintenance therapy for granulomatosis with polyangiitis and microscopic polyangiitis[J]. J Rheumatol, 2012, 39(1): 125-130. DOI: 10.3899/jrheum.110143.
- 9. Foster CS, Chang PY, Ahmed AR. Combination of rituximab and intravenous immunoglobulin for recalcitrant ocular cicatricial pemphigoid: a preliminary report[J]. Ophthalmology, 2010, 117(5): 861-869. DOI: 10.1016/j.ophtha.2009.09.049.
- 10. Anhalt GJ, Morrison LH. Bullous and cicatricial pemphigoid[J].J Autoimmun, 1991, 4(1): 17-35.
- 11. You C, Lamba N, Lasave AF, et al. Rituximab in the treatment of ocular cicatricial pemphigoid: a retrospective cohort study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(6): 1221-1228. DOI: 10.1007/s00417-017-3603-3.
- 12. Meijer JM, Meiners PM, Vissink A, et al. Effectiveness of rituximab treatment in primary Sjögren's syndrome: a randomized, double-blind, placebo-controlled trial[J]. Arthritis Rheum, 2010, 62(4): 960-968. DOI: 10.1002/art.27314.
- 13. Ebrahimiadib N, Modjtahedi BS, Roohipoor R, et al.Successful treatment strategies in granulomatosis with polyangiitis-associated peripheral ulcerative keratitis[J].Cornea, 2016, 35(11): 1459-1465. DOI: 10.1097/ICO.0000000000000919.
- 14. Guindolet D, Reynaud C, Clavel G, et al. Management of severe and refractory Mooren's ulcers with rituximab[J]. Br J Ophthalmol, 2017, 101(4): 418-422. DOI: 10.1136/bjophthalmol-2016-308838.
- 15. Kurz PA, Suhler EB, Choi D, et al. Rituximab for treatment of ocular inflammatory disease: a series of four cases[J].Br J Ophthalmol, 2009, 93(4): 546-548. DOI: 10.1136/bjo.2007.133173.
- 16. Lasave AF, You C, Ma L, et al. Long-term outcomes of rituximab therapy in patients with noninfectious posterior uveitis refractory to conventional immunosuppressive therapy[J]. Retina, 2018, 38(2): 395-402. DOI: 10.1097/IAE.0000000000001563.
- 17. Davatchi F, Shams H, Rezaipoor M, et al. Rituximab in intractable ocular lesions of Behcet's disease; randomized single-blind control study (pilot study)[J]. Int J Rheum Dis, 2010, 13(3): 246-252. DOI: 10.1111/j.1756-185X.2010.01546.x.
- 18. Perosa F, Favoino E, Caragnano MA, et al. CD20: a target antigen for immunotherapy of autoimmune diseases[J]. Autoimmun Rev, 2005, 4(8): 526-531. DOI: 10.1016/j.autrev.2005.04.004.
- 19. Bonavida B. What signals are generated by anti-CD20 antibody therapy?[J]. Curr Hematol Malig Rep, 2006, 1(4): 205-213. DOI: 10.1007/s11899-006-0001-z.
- 20. Perosa F, Prete M, Racanelli V, et al. CD20-depleting therapy in autoimmune diseases: from basic research to the clinic[J].J Intern Med, 2010, 267(3): 260-277. DOI: 10.1111/j.1365-2796.2009.02207.x.
- 21. Arkfeld DG. The potential utility of B cell-directed biologic therapy in autoimmune diseases[J]. Rheumatol Int, 2008, 28(3): 205-215. DOI: 10.1007/s00296-007-0471-x.
- 22. Dörner T, Lipsky PE. B-cell targeting: a novel approach to immune intervention today and tomorrow[J].Expert Opin Biol Ther, 2007, 7(9): 1287-1299. DOI: 10.1517/14712598.7.9.1287.
- 23. Smith JR, Stempel AJ, Bharadwaj A, et al. Involvement of B cells in non-infectious uveitis[J]. Clin Transl Immunology, 2016, 5(2): 63. DOI: 10.1038/cti.2016.2.
- 24. Heiligenhaus A, Miserocchi E, Heinz C, et al. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab)[J]. Rheumatology (Oxford), 2011, 50(8): 1390-1394. DOI: 10.1093/rheumatology/ker107.
- 25. Miserocchi E, Pontikaki I, Modorati G, et al. Rituximab for uveitis[J].Ophthalmology, 2011, 118(1): 223-224. DOI: 10.1016/j.ophtha.2010.07.031.
- 26. Parikh JG, Tawansy KA, Rao NA. Immunohistochemical study of chronic nongranulomatous anterior uveitis in juvenile idiopathic arthritis[J]. Ophthalmology, 2008, 115(10): 1833-1836. DOI: 10.1016/j.ophtha.2008.03.027.
- 27. Nguyen QD, Humphrey RL, Dunn JP, et al. Elevated vitreous concentration of monoclonal immunoglobulin manifesting as schlieren in juvenile rheumatoid arthritis-associated uveitis[J]. Arch Ophthalmol, 2001, 119(2): 293-296.
- 28. Shimada H, Yuzawa M, Hirose T, et al. Pathological findings of multifocal choroiditis with panuveitis and punctate inner choroidopathy[J].Jpn J Ophthalmol, 2008, 52(4): 282-288. DOI: 10.1007/s10384-008-0566-2.
- 29. Xu C, Ricciuti A, Caturegli P, et al. Autoimmune lymphocytic hypophysitis in association with autoimmune eye disease and sequential treatment with infliximab and rituximab[J].Pituitary, 2015, 18(4): 441-447. DOI: 10.1007/s11102-014-0592-7.
- 30. Saouli Z, Papadopoulos A, Kaiafa G, et al. A new approach on bullous pemphigoid therapy[J]. Ann Oncol, 2008, 19(4): 825-826. DOI: 10.1093/annonc/mdn046.
- 31. Reguiaï Z, Tchen T, Perceau G, et al.Efficacy of rituximab in a case of refractory bullous pemphigoid[J]. Ann Dermatol Venereol, 2009, 136(5): 431-434. DOI: 10.1016/j.annder.2008.10.038.
- 32. Schmidt E, Seitz CS, Benoit S, et al. Rituximab in autoimmune bullous diseases: mixed responses and adverse effects[J].Br J Dermatol, 2007, 156(2): 352-356. DOI: 10.1111/j.1365-2133.2006.07646.x.
- 33. Schumann T, Schmidt E, Booken N, et al. Successful treatment of mucous membrane pemphigoid with the anti-CD-20 antibody rituximab[J]. Acta Derm Venereol, 2009, 89(1): 101-102. DOI: 10.2340/00015555-0560.
- 34. Rübsam A, Stefaniak R, Worm M, et al. Rituximab preserves vision in ocular mucous membrane Pemphigoid[J]. Expert Opin Biol Ther, 2015, 15(7): 927-933. DOI: 10.1517/14712598.2015.1046833.
- 35. Hardy S, Hashemi K, Catanese M, et al. Necrotising scleritis and peripheral ulcerative keratitis associated with rheumatoid arthritis treated with rituximab[J]. Klin Monbl Augenheilkd, 2017, 234(4): 567-570. DOI: 10.1055/s-0042-121315.
- 36. Huerva V, Sanchez MC, Traveset A, et al. Rituximab for peripheral ulcerative keratitis with wegener granulomatosis[J].Cornea, 2010, 29(6): 708-710. DOI: 10.1097/ICO.0b013e3181c296ed.
- 37. Freidlin J, Wong IG, Acharya N. Rituximab treatment for peripheral ulcerative keratitis associated with Wegener's granulomatosis[J].Br J Ophthalmol, 2007, 91(10): 1414. DOI: 10.1136/bjo.2006.113316.
- 38. Baslund B, Wiencke AK, Rasmussen N, et al. Treatment of orbital inflammation with rituximab in Wegener's granulomatosis[J].Clin Exp Rheumatol, 2012, 30(1 Suppl 70): S7-10.
- 39. Taylor SR, Salama AD, Joshi L, et al. Rituximab is effective in the treatment of refractory ophthalmic Wegener's granulomatosis[J]. Arthritis Rheum, 2009, 60(5): 1540-1547. DOI: 10.1002/art.24454.
- 40. Joshi L, Lightman SL, Salama AD, et al. Rituximab in refractory ophthalmic Wegener's granulomatosis: PR3 titers may predict relapse, but repeat treatment can be effective[J]. Ophthalmology, 2011, 118(12): 2498-2503. DOI: 10.1016/j.ophtha.2011.06.009.
- 41. Skelsey ME, Mayhew E, Niederkorn JY. CD25+, interleukin-10-producing CD4+ T cells are required for suppressor cell production and immune privilege in the anterior chamber of the eye[J]. Immunology, 2003, 110(1): 18-29.
- 42. Cousins SW, McCabe MM, Danielpour D, et al. Identification of transforming growth factor-beta as an immunosuppressive factor in aqueous humor[J].Invest Ophthalmol Vis Sci, 1991, 32(8): 2201- 2211.
- 43. Taylor AW. Ocular immune privilege[J].Eye (Lond), 2009, 23(10): 1885-1889. DOI: 10.1038/eye.2008.382.
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