“The Type 1 diabetologists are way ahead of us in that they have a very good idea of what autoantigens are driving their disease. The study below shows that B cell depletion with rituximab in type 1 diabetes only has a temporary impact on autoimmune B cell responses. The autoreactive cells bounce back quickly post-rituximab treatment. In short anti-CD20 therapies are not the holy grail when it comes to treating autoimmunity. This would be consistent with the experience of anti-CD20 therapies in MS and makes a case for using anti-CD20 treatments as a maintenance treatment, i.e. given continuously, rather than an induction treatment. The real questions that will be need to be answered ASAP; does maintenance anti-CD20 treatment prevent progressive MS?”
Background: Type 1 diabetes (T1D) patients show abnormalities in early B cell tolerance checkpoints, resulting in the accumulation of large numbers of autoreactive B cells in their blood. Treatment with rituximab, an anti-CD20 mAb that depletes B cells, has been shown to preserve β cell function in T1D patients and improve other autoimmune diseases, including rheumatoid arthritis and multiple sclerosis. However, it remains largely unknown how anti-B cell therapy thwarts autoimmunity in these pathologies.