Wading Through The Initial Hype Of B-Lymphocyte Depletion Therapy
On November 1, 2000, research findings about B-lymphocyte depletion therapy, a potential new treatment for rheumatoid arthritis were presented at the annual American College of Rheumatology conference. These new findings were so exciting that some in the media began calling B-lymphocyte depletion therapy a "cure" for rheumatoid arthritis.After The Frenzy
After the media frenzy, some backpedaling about B-lymphocyte depletion therapy has since occurred when it was realized that the trial size to date has been extremely small and that more research is needed.
The three drugs used for B-lymphocyte depletion therapy (prednisolone, rituximab, and cyclophosphamide) are available but are not yet approved or licensed for autoimmune diseases. Controlled trials are currently in progress and in December 2000, trials will continue in the United Kingdom at UCLH in London and at Cannock Chase Hospital. Trials will also begin at Garvan Institute in Sydney, Australia and at other trial centers in Europe and Canada.
The trials are being conducted by Hoffman la Roche. It is expected that if current trials continue to show positive results, in about a year, larger trials in more centers will commence. Rheumatoid arthritis patients who have a positive rheumatoid factor, take the drug methotrexate, and still have symptoms in multiple joints may be considered for a trial, with a referral from their rheumatologist.
Some Critical Of The Hype
An article in the British Medical Journal (BMJ) was critical of the hype caused by the media frenzy over the B-lymphocyte depletion therapy research. The BMJ review denounced the reporting of journalists as irresponsible. Dr. Jonathan C. Edwards responded to the negative review by writing in part, "The word cure, in the form "possible cure" has been on my web site for two years. Our treatment was specifically designed to be a cure, in contrast to all treatments for arthritis other than high dose chemotherapy and stem cell rescue. Robert Matthews (from the Sunday Telegraph) used the word appropriately. Others may not have. We have not claimed a cure, merely that we had set out to cure and that results so far are as good as we had hoped on the first attempt and extremely useful in the short term."
Hope Remains Strong
What is certain is that patients with rheumatoid arthritis and other autoimmune diseases, along with the medical community, will keep a close eye on reports about B-lymphocyte depletion therapy. The hype may have dissipated, but the hope which has been generated remains strong.
Editor note: On 3/01/2006, Rituxan (rituximab) was FDA approved to be used in combination with methotrexate to treat rheumatoid arthritis by reducing the signs and symptoms in adult patients who have moderately-to-severely active rheumatoid arthritis and have failed one or more anti-TNF drugs e.g. Enbrel (etanercept), Remicade (infliximab), or Humira (adalimumab). See: Rituxan Approved For Rheumatoid Arthritis - The Facts Of Rituxan
Related Resources - B-Lymphocyte Depletion Therapy
Sources: Update on B Lymphocyte Depletion Therapy, B Cell Therapeutics Group; Arthritis cure: the facts behind the hype, British Medical Journal, BMJ 2000;321:1232, November 11, 2000
