B cell or T cell-dominant recurrence after rituximab therapy in patients with SLE

Systemic lupus erythematosus (SLE) is an autoimmune disease induced by autoreactive T cell activation and B cell autoantibody overproduction. The efficacy of rituximab in refractory SLE has been documented, although some patients show partial response only.1,–,9 We report here two patients with SLE who showed T cell-dominant flare-up and two others who showed B cell-dependent flare-up, after long-term remission induced by rituximab administered at 375 mg/m2 twice/week. Rituximab rapidly depleted peripheral naive and memory B cells in patients with SLE. Patients with prolonged remission had persistent depletion of memory B cells for >2 years, whereas recovery of naive B cells occurred within 3–9 months. The expression levels of CD80 on B cells diminished rapidly and remained downregulated. Furthermore, CD69 and ICOS (inducible T-cell co-stimulator) expression levels on CD4+ T cells also decreased and remained at low levels.10 B cell-dominant recurrence occurred in two patients, who were concurrently positive for anti-ds-DNA antibodies and extractable nuclear antigen, with lupus nephritis (class II) before treatment …