A single infusion of 1,000 mg of rituximab may significantly delay the onset of clinical signs and symptoms of arthritis in subjects at high risk of developing seropositive rheumatoid arthritis (RA), according to the exploratory, randomized, double-blind, placebo-controlled PRAIRI (prevention of clinically manifest rheumatoid arthritis by B cell directed therapy in the earliest phase of the disease) study.1 The results were published in the February 2019 issue of Annals of the Rheumatic Diseases, and the initial presentation of the abstract was made during the 2016 ACR/ARHP Annual Meeting.2
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“We have created the first experimental evidence in humans that B cells play a critical role in the pathogenesis of RA during the preclinical stage of the disease,” says the study’s lead author Paul Peter Tak, MD, PhD, FMedSci, professor of medicine in the Division of Clinical Immunology and Rheumatology at the Academic Medical Center of the University of Amsterdam, The Netherlands.
“These findings also support future studies aimed at secondary prevention of RA, including by the use of targeted treatments,” Dr. Tak says.3
Previous research identified rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPAs) in the peripheral blood of individuals less than 10 years before they develop autoantibody positive RA.4,5 B cells are known to be efficient antigen-presenting cells that produce autoantibodies and may activate T cells in the context of co-stimulatory signals, producing a variety of cytokines.6