Review of an Anti-CD20 Monoclonal Antibody for the Treatment of Autoimmune Diseases of the Skin

Abstract

Biologic therapies targeting B-cells are emerging as an effective strategy to treat a variety of immune-mediated diseases. One of the most studied B-cell-targeted therapies is rituximab, an anti-CD20 monoclonal antibody that exemplifies B-cell depletion therapy and has served as the prototype for other anti-CD20 monoclonal antibodies and the development of biosimilars. While there are multiple studies on the use of rituximab in dermatology, a comprehensive review of rituximab therapy in autoimmune skin conditions is lacking. In this literature review, we summarize indications, treatment efficacy, and safety of rituximab among common autoimmune diseases of the skin: pemphigus vulgaris, cutaneous lupus erythematous, dermatomyositis, systemic sclerosis, thyroid dermopathy, autoimmune pemphigoid diseases, and cutaneous vasculitis diseases. Existing data on rituximab support the approach of rituximab, biosimilars, and newer B-cell-targeting therapies in immune-mediated cutaneous diseases. Overall, rituximab, which targets CD20, provides an effective alternative or concomitant option to traditional immunosuppressants in the management of various autoimmune diseases of the skin. Further studies are necessary to expand the understanding and possible utility of B-cell-targeted therapies among autoimmune skin diseases.

Neutrophil-Derived IL-6 Potentially Drives Ferroptosis Resistance in B Cells in Lupus Kidney

“…This study, however, discovered that a population of neutrophil could provide IL-6 for B cells and suppress ferroptosis in lupus kidney, via SLC7A11. This discovery would improve the understanding of the cross-talk between neutrophils and B cells and help provide an alternative strategy for suppressing the pathological features of B cells in lupus [ 35 , 36 ].…”

A Comprehensive Review on the Efficacy of Anti-CD20 Therapies in Pemphigus Treatment

“…Moreover, rituximab, an anti-CD20 monoclonal antibody, has received FDA approval to treat pemphigus vulgaris in adults [ 32 ]. Rituximab has effectively managed refractory pemphigus vulgaris, improving laboratory and clinical outcomes [ 31 , 33 ]. A case-control trial revealed enhanced laboratory and clinical outcomes in patients treated with rituximab compared to those receiving mycophenolate mofetil or azathioprine [ 34 ].…”

“…A case-control trial revealed enhanced laboratory and clinical outcomes in patients treated with rituximab compared to those receiving mycophenolate mofetil or azathioprine [ 34 ]. However, the response of mucous membranes and cutaneous folds may exhibit delays [ 33 ]. Despite this, rituximab is generally safe and well-tolerated, with infusion-related reactions being the most common adverse reaction observed [ 31 , 33 ].…”

“…However, the response of mucous membranes and cutaneous folds may exhibit delays [ 33 ]. Despite this, rituximab is generally safe and well-tolerated, with infusion-related reactions being the most common adverse reaction observed [ 31 , 33 ]. Therefore, personalized medicine in pemphigus can be actualized through the identification and cloning of several pemphigus/pemphigoid autoantigens, alongside the effective utilization of rituximab as an approved treatment option for pemphigus vulgaris in adults.…”

Novel Therapeutic Strategies in the Treatment of Systemic Sclerosis

“…B cell-targeting therapy is currently licensed in the treatment of rheumatoid arthritis and ANCA vasculitis but is also successfully used off-label in other immune-mediated diseases [ 124 , 125 , 126 ]. Unfortunately, most B cell-depleting therapies target the CD20 molecule expressed on the surface of the majority of B cells.…”