Anti-CD20 (rituximab) treatment improves atopic eczema

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:121

Article

Simon, Dagmar²  Hosli, Susanne¹  Kostylina, Ganna¹  Yawalkar, Nikhil²  Simon, Hans-Uwe¹ 

[1] Univ Bern, Dept Pharmacol, CH-3010 Bern, Switzerland

[2] Univ Bern, Dept Dermatol, CH-3010 Bern, Switzerland

关键词: atopic dermatitis;    B cells;    biologics;    cytokines;    inflamation;    rituximab;    T cells;   

DOI  :  10.1016/j.jaci.2007.11.016

来源: Elsevier

【 摘 要 】

Background: Atopic eczema (AE) is a chronic inflammatory skin disorder characterized by eczematous skin lesions, pruritus, and typical histopathologic features. Objective: We asked whether depletion of B cells by monoclonal anti-CD20 antibody therapy (rituximab) would improve severe AE. Methods: Six patients (4 women and 2 men) with severe AE received 2 intravenous applications of rituximab, each 1000 mg, 2 weeks apart. To evaluate the efficacy of rituximab, we monitored clinical parameters (eczema area and severity index, pruritus), total and allergen-specific IgE levels, skin histology, and inflammatory cells and cytokine expression in the skin and peripheral blood before and after therapy (ClinicalTrials.gov Identifier: NCT00267826). Results: All patients showed an improvement of their skin symptoms within 4 to 8 weeks. The eczema area and severity index significantly decreased (before therapy, 29.4 +/- 4.3; week 8, 8.4 +/- 3.6; P <.001). Histologic alterations such as spongiosis, acanthosis, and dermal infiltrate, including T and B cell numbers, also dramatically improved. However, whereas blood B cells were below detectable levels as a consequence of rituximab administration, skin B cells were reduced by approximately 50% only. Expression of IL-5 and IL-13 was reduced after therapy. Moreover, whereas allergen-specific IgE levels were not altered, we observed a slight reduction in total IgE concentrations in blood. Conclusions: B cells play a major role in AE pathogenesis. Treatment with an anti-CD20 antibody leads to an impressive improvement of AE in patients with severe disease.

【 授权许可】

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