Review of Biologics in Children With Rheumatic Diseases

Shabina Habibi; Athimalaipet V Ramanan

Disclosures

Int J Clin Rheumatol. 2012;7(1):81-93. 

In This Article

Anti-B-cell Therapy

Rituximab is a chimeric anti-CD20 antibody that binds to and causes apoptosis of CD20-positive cells, causing prolonged depletion of B cells. It has been found to be an effective treatment option for the treatment of rheumatoid arthritis. There is just one trial of its efficacy in children with refractory JIA.[54] Fifty-five children with refractory polyarticular and systemic JIA were given 4 weekly infusions of rituximab at a dose of 375 mg/m2/dose, repeated if necessary. At week 24, ACR-Pedi 30, 50, 70 responses were attained by 98, 50 and 40% respectively. At 96 weeks, these responses were attained by 98, 93 and 93% of 25 patients. High rates of remission were also noted with repeated courses, with 25% patients after the first course and 98% after the fourth course attaining remission. It has been found to be effective in some case reports and case series.[55–57] Contrary to the experience in adults treated with rituximab, children may develop long-lasting B-cell depletion and hypogammaglobulinemia, sometimes requiring replacement immunoglobulin replacement.[58] Incomplete maturation of the immune system in children may limit widespread B-cell depletion therapy in children.

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