Autoimmune Sequelae Following Rituximab Therapy

A Review of the Literature and Potential Immunologic Mechanisms

Anna E. Kersh, MD, PhD; Ron J. Feldman, MD, PhD


J Clin Rheumatol. 2018;24(8):427-435. 

In This Article


The development of autoimmunity in patients receiving rituximab illustrates the complexity of immune cell interactions and the delicate balance that allows for the elimination of pathogens while avoiding self-directed immune responses. The majority of described reactions occur in the skin and lungs, which suggests a role for tissue-resident lymphocytes in autoimmune pathogenesis. Resident memory T cells are known to be a nonrecirculating population within a tissue and the processes that regulate these cells have not been thoroughly explored.[46]

The irony that some rituximab-induced autoimmune responses are, in other circumstances, treated with rituximab highlights the significance of other cellular, genetic, and environmental factors that influence individual immune responses.[15,56] It is possible that autoimmune reactions to rituximab are underappreciated as patients are often concomitantly treated with other immune-suppressing therapies.[6,11] These intricacies of the immune system and the degree to which individual variation affects response to treatment encourage the cautious and thoughtful use of B-cell–depleting therapies in patients with existing altered immune milieu.