B-cell-targeted therapies in systemic lupus erythematosus and ANCA-associated vasculitis: current progress

Abstract

B cells play a central role in the pathogenesis of systemic lupus erythematosus and anti-neutrophil cytoplasmic antibody-associated vasculitis. There are various strategies for targeting B cells including depletion, inhibition of survival factors, activation and inhibition of co-stimulatory molecules. Controlled trials in systemic lupus erythematosus have shown positive results for belimumab, promising results for epratuzumab and negative results for rituximab. The failure of rituximab in controlled trials has been attributed to trial design, sample size and outcome measures rather than true inefficacy. In anti-neutrophil cytoplasmic antibody-associated vasculitis, rituximab is effective for remission induction and in relapsing disease. However, the optimal long-term re-treatment strategy remains to be determined. Over the next 5 years, evidence will be available regarding the clinical efficacy of these novel therapies, biomarkers and their long-term safety.

Keywords::

• ANCA-associated vasculitis
• B cells
• belimumab
• biologics
• rituximab
• systemic lupus erythematosus

Financial & competing interests disclosure

MY Md Yusof is an NIHR Academic Clinical Fellowship trainee and has no conflict of interest. EMJ Vital is an NIHR Clinical Lecturer and has received honoraria and research grant support from Roche and GSK. P Emery has received consultant fees from BMS, Abbott, Pfizer, MSD, Roche and UCB. P Emery has received research grants paid to his employer from Abbott, BMS, Pfizer, MSD and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.