Revisiting B-cell targeted therapies in rheumatoid arthritis: from paradoxical biology to deep immune reset - PubMed
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- #B-cell depletion
- #Rituximab resistance
- #CAR-T therapy
- B-cell targeted therapies in rheumatoid arthritis (RA) are revisited, focusing on rituximab and its limitations.
- High-resolution data reveals paradoxical B-cell biology, including protective ACPA clones and regulatory B cells.
- Mechanisms of rituximab resistance include survival of CD20-negative plasmablasts, persistent BCR clonotypes, and Breg eradication.
- Updated guidelines (EULAR/ACR) position rituximab for high-risk patients, like those with RA-ILD or recent malignancies.
- A shift to 'deep immune reset' via CD19-directed CAR T-cell therapy shows promise for drug-free remission in refractory RA.